Why is no one talking about for-profit home care?

The pandemic drew attention to decades-long problems in long-term residential care in Canada — resulting in tragic loss of life for thousands, and loss of quality of life for the many more who experienced isolation and inadequate care during pandemic lockdowns.

Research has demonstrated that COVID-19-related mortality and inadequate care during the pandemic was most pronounced within for-profit long-termcare facilities.

Unsurprisingly, political organizations and advocates have called for the elimination of for-profit provision of residential care across the country. Many of the same critics have called on increased provision of home care as a solution. But there has been relative silence about the for-profit model in home care too.

Why is no one talking about for-profit home care in Canada?

Given the rise in demand for home care, the acceleration of private home-care services, and our rapidly aging population, the role of profit in home care should also be front and centre in our public discourse.

In Canada, home care involves a complex and often confusing mix of public, for-profit and not-for-profit organizations delivering services across the country, often, but not always using a kind of managed competition model. Although publicly funded to varying degrees by the provinces, many Canadians pay personally for services, either to top-up publicly funded services or replace them.

Poorly funded public services can mean wealthier families turn more frequently toward for-profit agencies. Although there is heavy reliance on not-for-profit care providers in this sector, some regions (particularly Ontario) have seen expansion of for-profit home care delivery.

With colleagues, we conducted a review of mainstream media articles on home care in Canada. We found that during the pandemic, articles addressing the issue of home care emphasized the safety, desirability and comfort of home care compared to residential care, but never questioned the profit-model in home care the way they do in residential care.

Problematically, we also found that despite the considerable variability in home care across Canada, media articles conveyed a sense of home care as a singular entity. The outlier was a newly released CBC Marketplace investigation which revealed disturbing concerns with home-care quality and accountability in

Ontario (where for-profit companies play a significant role in delivery).

Analyses of for-profit home care in Canada are also largely ignored in academic research.

In the 1990s, when Manitoba shifted a small portion of its home care from public to for-profit delivery, it was found not only to be more expensive for government but had higher worker turnover. Yet despite these findings, little academic research has been done on the for-profit model in home care across Canada.

There is also concern for potential conflicts of interest amid the expansion of for-profit care delivery.

We should not give this sector a free pass. It’s time the nation turned its eyes to for-profit home care. Is this the path we want to traverse?

As home care is more and more frequently turned to as the fix for long-term residential care woes, we need to more carefully assess the profit-model of home care. It appears we are rapidly heading in this direction — so, it’s long past time for a public discussion.