What Is Long Term Care, and What Does It Need to Be?

Long-Term Care facilities have been the sites of deadly COVID-19 outbreaks, in Alberta and across the country. But what is long-term care? How is it funded, and who operates it? What are conditions like for persons in care, as well as for workers? Lastly, as our aging population requires increasing care, how might we build a system that treats our elders and those who cannot work with dignity and respect— while providing low-carbon, green care-work jobs?

Further Reading:
Re-imagining Long-term Residential Care in the COVID-19 Crisis (Canadian Centre for Policy Alternatives, April 2020)
Losing Ground: Alberta’s Residential Elder Care Crisis (Parkland Institute, 2016)
Deaths in Residential Care in Canada by facility (tracker updated daily by Nora Loreto)
Sizing Up the Challenge: Meeting the Demand for Long-Term Care in Canada (Conference Board of Canada, 2017)
Before It’s Too Late: A National Plan for Safe Seniors’ Care (Canadian Federation of Nurses Unions, 2015)

A transcript follows the break.

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Kate: Hello, and welcome to The Alberta Advantage. My name is Kate Jacobson, and joining Team Advantage today is Joel —

Joel: Hello, hello.


Kate: — and Trevor.

Trevor: Hi there.

Kate: Our topic today is long-term care, and, over the past couple of months of this pandemic that we’re currently living in, you may have noticed that many of the COVID-19 outbreaks that have been reported have taken place at long-term care facilities. And, while there’s been quite a bit of reporting about the how and the why of the outbreaks in these particular facilities, we thought it would be an opportune time to look at long-term care more broadly. Where did it come from? Who are the major people and actors who benefit from the current long-term care system we have set up? How does our society treat the elderly and the people who care for them? Is the system we have now a desirable one, and can it be improved? So, instead of looking at the specifics of long-term care outbreaks in X site or Y site, this episode is going to be more about the system of long-term care that exists in Alberta and how the conditions of that led to the outbreaks that we’re seeing right now due to COVID-19.

Joel: So, a good place to start is just to ask basic questions about defining our terms. So, here’s the big one: what is long-term care, and how did it come to be?

Kate: So, long-term care is really a circa-World War II expansion of the welfare state phenomenon. Basically, prior to World War II, Canadians who were older, who were sick, who were disabled had to rely on private markets, on charity, and on their communities for care, and a lot of this was reliant on the unwaged labour of women in private, domestic households. Post-World War II, you see things like lodges, home care, auxiliary hospitals, and nursing homes being established and built.

Trevor: And you can get a lot of this history from advocates like Carol Wodak — who’s on the Public Interest Alberta seniors task force — and one of the things she will talk about is, at the tail end of the last Social Credit government in the 1970s, they banned private nursing homes because it was believed they were not getting adequate care for the money they spent. What happened after that? Well, we had to fast-forward to the 1980s, and the Alberta government commissioned the Mirosh Report — it was called “A New Vision For Long-Term Care” — and they talked about shifting responsibility and cost from government onto individuals and families, because choice was important, you see. At the time, the opposition New Democrats, they said this was a bad idea, so, naturally, those values carried through to when they formed government, I’m sure.

Kate: Obviously. And one of the things I want to be really clear about right off the bat is defining the terms that we’re going to be using throughout this episode, because there’s a lot of different words which seem like they are referring to the same thing but actually have differences that are basis of the issues that exist in our long-term care system. So, what long-term care is is facility-based care for, mostly, seniors, but also any Albertan who is in need of, basically, complex care that is requiring assessment or care from a registered nurse. So, this is going to be your home — you will be living in care. A lot of these furnishings are already provided. Many seniors living in care share homes or share rooms and, if you’re not sharing, you are paying more. All of the healthcare services in long-term care are provided on site. This includes doctors’ visits, medication is covered by Alberta Health Services, so users of this long-term care system basically only pay for accommodation charges, and then they also pay fees for support services, things like laundry and meals. The bulk of the nursing care is provided by licensed practical nurses, and the majority of the workforce are healthcare aides, sometimes called personal support workers (the precise terminology changes from province to province). And then there’s also workers who are providing what we call general support services — so, these are things like meals, recreation, laundry, maintenance, housekeeping — basically, any work that goes into making these homes run that isn’t direct patient care. And one thing that’s also really important, here, when looking at long-term care, is that these care centres also rely on a lot of volunteer labour — this is from friends, family, community volunteer supporters, things like that.

Trevor: So, that’s an important definition to get a look at — long-term care — but there are other pieces to this puzzle which do come into play. In the 1990s, our glorious leader Ralph Klein decided that deficit were very, very important, and so we had to look at ways to get private industry involved so the government would spend less money on caring for our sick and elderly. And so one of the things they did was a heavy emphasis away from long-term care and onto something called “assisted living” — we now call that “designated supportive living.” And these homes were more attractive to the private sector for a few reasons: your medications were covered, so, hey, someone can make money off that; fee structures have fewer regulations, so these profit-seekers can make even more money off of meeting your basic needs (remember, you live there); there’s no requirement to have the higher-waged registered nurses on staff, and what’s really attractive is that you have a government-supplied steady stream of customers with guaranteed public funding for their care.

Kate: So, long-term care and designated supportive living homes are often referred to in combination as “continuing care centres,” and this is what, more broadly, we will be talking about in this episode, is what we’re going to call “continuing care.” And there’s been a lot of research done on this over the years, and recent research tells us that the state of continuing care in Alberta right now is, honestly, not great. So, before Ralph Klein got ahold of things, continuing care was 50% public, 25% for-profit, and 25% private sector not-for-profit; but, by 2016, only 21% of beds were owned and run by the public sector. So, this is basically long-term care homes and wards mostly attached to rural hospitals, and then Capital Care in Edmonton and Carewest in Calgary — these are wholly-owned subsidiaries of Alberta Health Services. And not only is the public share of beds in continuing care decreasing, but, also, these long-term care beds are decreasing in absolute terms. So, from 2008 to 2015, Alberta saw a 26.5% decline in available long-term care beds per every 1000 people over 85 years old. And that’s because the trend has been stagnant growth in long-term care, like Trevor said, or even a decline, as we see here, with a reliance on that designated supportive living that has more opportunities for privatization and, also, for financialization.

Joel: Alright. So, we’ve got a sense of what long-term care is and the general trend as far as the industry goes. Who are the major players? Who benefits from long-term care, and who pays into it? What are the inputs as far as funding goes?

Kate: I know Trevor’s going to get more into the specifics, but I just have to say: the major players in long-term care are a cast of the worst ghouls imaginable. Just, the worst people you can possibly imagine are all the major players in long-term care.

Trevor: Yeah. I mean, these are people who had the choice to say, “You know what? I might want to go and provide some care for people,” but then they thought, “Wait — what if I could make some money off of it, too?” So, this was something that was ramped up in the Klein years, and then Premier Stelmach put it on turbo in 2008 with a scheme they called “The Affordable Supportive Living Initiative” or, sometimes, ASLI. And, over the years, they’ve handed out over hundreds of millions of dollars to private providers to help them build new facilities — they get up to 50% of the costs covered, and guess what? We don’t get an equity stake in these companies, we don’t get a share of the revenues when they sell these buildings. These are just pure corporate handouts.

Kate: And our current government, under Jason Kenney, actually campaigned to ramp this up and put over $180,000,000 in funds over four years for new private builds. And this is just pure corporate handouts. It’s been said, but that’s the only to describe it — we are subsidizing the profit being made by these private companies. And not only are we subsidizing it, but the profit they are making in the first place is fairly immoral because they are profiting off of the care of our sick and elderly. So, if anyone listening to The Alberta Advantage is one of the nine members of the Canadian Taxpayers Federation, it would be awesome if you could shoot us an email and let us know when you plan on running some sort of campaign about all this public money that is going to private industry. The other issue is that, when these facilities do get built, they get a contract with Alberta Health Services to provide care, so a) basically figures out how sick the residents will be, what staffing mix they think is appropriate, what is costs Alberta Health Services to hire those staff, and then it gives the providers the equivalent funds. And this is the really, absolutely despicable part — as best as we can tell, there are not strings attached to these funds, so if a healthcare aide is making $24/hr at AHS, the private sector can pay them $20/hr and there doesn’t really appear to be anything that stops them from pocketing the difference. So, they routinely underpay staff who have the exact same qualifications and licensing as their coworkers in Alberta Health Services, and then they pocket the difference and they pay it out to their shareholders. So, running one of these homes is like having a license to print money — it is truly disgusting.

Joel: I just want to clarify. So, AHS pays the private sector actor $24/hr for someone to provide care, and then that same company pays the employee $20.

Kate: This is something that happens in continuing care as best as we can tell. It is the only way I can think of to explain the vast differences that exist in compensation levels between private and not-for-profit continuing care and public continuing care.

Trevor: Yeah. And if you have followed any of the strikes that have happened in the industry, it’s been regularly discussed that the wages can be 20, 30% off from Alberta Health Services standards that are established. And we have to say “as best we can tell” because there’s no transparency for the contracts that we enter into with these private providers. We don’t get to know how this is being accounted; we don’t get to know how this is fuelling their profit margins. So, that’s how the care side of things are funded, and the way the system is run, they separate the care provided by registered nurses, licensed practical nurses, healthcare aides, and then what they call “support services,” or, sometimes, even “hospitality services,” and that’s where residents are paying out of pocket for their accommodation — that part is regulated. You can be paying maybe $1700 a month for a standard room, but then the fees start coming in. And the industry, as it were, is not terribly transparent about this. If you want to go onto an extended care or Chartwell website and look for this information, how much is it going to cost you to live there, it seems like a maze, and I have not been able to find it on many of these sites — but, in one place, Points West Living (kudos to them, I guess), they’ll tell you you’re going to be paying over $2000 a month for supportive living, accommodations, and some basic services, but you’re going to have to pay more on top of that, I’m sure.

Kate: But we know, or we can do some investigation, because — unfortunately — long-term care insurance is a thing, and the Canadian Life and Health Insurance Association tells us that the average cost for a continuing care space in Canada can be between $35,000 to $65,000 a year, and they also expect the long-term care costs for boomers, basically, over the next 35 years to be $1,200,000,000,000, and only half of that to be publicly funded (so, that means that we’re paying the rest). And they estimate Alberta costs as high as $44,000 per month in a private room.

Trevor: So, while I was trying to find some of these costs on these private providers’ websites, I found a video on one website where they talked about how you should be looking at what assets your parents have so that you can sell them off so they can afford to stay there.

Kate: That is truly disgusting. A common theme in this episode. God, I hate these people so much. Anyways, let’s talk specifically about some of the actors in continuing care so we can find precise and specific ways to hate these people.

Joel: Yeah. So, who is it that’s making money off the system? Who are the major players within the industry?

Trevor: Alright, let’s go to the gallery of ghouls.

Kate: [laughs]

Trevor: Why don’t we start with Revera? Revera, you may have heard them in the news — this company has billions of dollars in assets. They say they operate over 500 properties — not just in Canada, but in the UK — here in Alberta, I think there’s at least 16 facilities. They are no strangers to labour negotiations — we saw a strike that was successful for the workers at Revera Riverbend in Edmonton in 2012, and they continued to be in the news last year. We read in CBC that they are facing at least 85 lawsuits from residents and families over issues like low staffing ratios. And then, on April 30th, they’re in the news again — there’s a class action lawsuit being launched in Toronto over alleged negligence in their pandemic response. And you’ve probably heard locally, in the news, over an outbreak at McKenzie Towne in Calgary where, to date, at least 22 residents have died. And that’s been as much as 35% of all continuing care deaths in Alberta, at one site. Shout out to Nora Loreto for doing great work tracking all of that. And we just learned, on May 12th, that another lawsuit has been launched on Revera, and that is for McKenzie Towne. I’m not one of those fiscal conservative types, but maybe — just maybe — having to defend yourself against constant lawsuits is money that could be better spent taking care of these people in the first place.

Kate: And one of the interesting things about Revera is: it was a publicly traded corporation until 2007, when it was actually bought out by the public-sector pension investment board for a pension plan that covers people in Canada’s military, RCMP, and the federal public service — and, for more information about how pension funds, writ large, make working people complicit in the perpetuation of capitalism and liberalism and privatization, I really do recommend the episode we did on pensions a couple months ago. What’s also interesting about this pension plan is that it given annual reports. Unfortunately, they don’t tell us a ton about Revera’s operations, but it does tell us that the plan considers them to be a real estate asset, and that’s actually something that’s really common across a lot of continuing care. And when I first learned about this, it struck me as incredibly grotesque, that we have this entire system that is about taking care of our sick and our elderly, and to capital and to financial investors, they see it the same as real estate. And I think that is true of real estate in general — what financial speculators call real estate, I would maybe call people’s homes or where they live, and this is a heightened example of how awful that phenomenon is and how awful it is that financial speculators and pension plans kind of gamble with people’s lives like that, by calling it real estate.

Joel: Alright, I’m making a list and — Revera — okay. Who’s next?

Kate: So, next is Extendicare. They operate across Canada, and Alberta is their second-largest market — there is at least 15 facilities in the province. They are a publicly traded corporation — stocks are trading the $5 range these days, so you can trade four Extendicare shares for one barrel of Western Canadian Select, for our Albertan listeners. Their 2019 revenues — and this is truly disgusting — was $1,130,000,000, and the amount they paid in tax on those revenues was $7,200,000 — less than 1% of their revenues. Now, I am but someone who makes the median income, and I definitely pay more than 1% tax on my income, not just the money I have left over after I’ve paid everything out. And, not only that [laughs], their payout to six of their top executives in 2019 was over $7,000,000, and they paid out $37,000,000 in dividends to shareholders — so, again, if any members of the Canadian Taxpayers Federation are listening, could you please let us know when you will be doing some corny, prop-driven media stunt to highlight how this publicly-funded corporation is using taxpayer money that should go to care for seniors to pay millionaire executives.

Trevor: Clearly, these people deserve Jason Kenney’s corporate tax cut. So, like Revera, Extendicare are regularly in the news with lawsuits being brought up by their residents. And I’ve never been in this situation before, and I just can’t imagine having to sue the people who were responsible for providing shelter and care for you. That just drives me nuts. Also, labour-side — important to consider — Extendicare is highly unionized and, in 2013, hundreds of them at eight facilities were prepared to strike, but the PC government stepped in at the last minute to make the strike illegal, and they sent it to mediation. The NDP at the time was shocked and appalled that a government would dare step in and interfere with workers’ labour rights.

Kate: And, fortunately, they continued to believe that. So, next for your list, Joel, we have a company called Chartwell, which operates, again —

Joel: And — sorry — how is that spelled?

Kate: [laughs] Chartwell. C-H-A-R-T-well (as in wells where you get water from).

Joel: Okay, cool. Just making a list. For reasons.

Kate: Oh, perfect. So, Chartwell operates across the country, as I said, with over a dozen facilities in Alberta. Again, it is a publicly traded corporation — their stocks are around $8, so that is about three Chartwell shares for a barrel of Western Canadian Select if you are so inclined. Their CEO made $2,500,000 in compensation, with over $6,000,000 paid out to five named executive officers, with their revenues from last year at nearly a billion dollars. And, like Trevor mentioned, these are the companies that benefit from Jason Kenney’s multi-billion dollar corporate tax cut. These are the precise and exact people that that money is going to. And these same people, Chartwell, actually went ahead with staff layoffs at one of their Edmonton facilities in the middle of our current pandemic. And I really want to reiterate that, right now, we are in an unprecedented pandemic that is impacting long-term care and continuing care the most, and they are laying off staff.

Trevor: I didn’t think it was going to take me this long to get to this point, but hey, here it is. Fuck Chartwell. I’ve sweared on the podcast.

Kate: Finally. Fuck a lot of these people. But the other thing, too, is — Chartwell has their stock listed as a real estate trust, which, again, makes me want to bang my head against a wall. And my last fun Chartwell fact is that, recently, an Ontario class action lawsuit was actually launched against Chartwell for alleged failure in planning and responding to the current COVID-19 pandemic — so, a true litany of failures.

Joel: Okay, yeah. They’re definitely on my list. Next — anybody want to add to this list?

Trevor: Let’s keep going. So, next up is PWL — Points West Living. They’ve got centres in BC and Saskatchewan, but they’re mostly Alberta-based — I think they’ve got 11 facilities here. They are run for profit, as well. PWL is not publicly traded, so financial details are harder to come by. The company has said they expect its value to rise to $500,000,000 in the next two years, so maybe a little bit smaller than some of those big players. But it’s a good game to be in. In 2015, their CEO, Doug Mills, he got a cool $250,000 bonus in shares.

Joel: Trevor, that just sounds like a small business to me.

[laughter]

Joel: Just a mom and pop operation, taking care of people who need care.

Kate: Go fuck yourself. [laughs]

Trevor: Is this the part in the show where we ask everyone to do their part to support small businesses? During the pandemic, go down to your local PWL and clap because Doug Mills needs your support.

[laughter]

Trevor: So, not only does Doug Mills get recognized with his quarter-million dollar bonus, but in 2016 they won a private capital market award for commercial real estate. I’m going to say that again — a private capital market award for commercial real estate. Not for providing care. But you can see the theme here.

Kate: And one of the most important things to talk about when we talk about PWL is the story of how the Alberta NDP handled continuing care, and you can pretty much tell the whole story through Points West Living because, after taking power, the Alberta NDP approved dozens of private continuing care sites to build new facilities despite their platform saying that they would end PC experiments in privatization and invest in the public system. They knew private continuing care was a problem, and still, the only new beds they promised in their platform were 2000 new public beds. By the time they lost the election in 2019, zero new public beds had been built. They are 0 for 2000 on building continuing care beds. Their very late in the game shift in 2018 to investing only in new public or not-for-profit beds has been completely scrapped with the election of the UCP — a common Alberta NDP story — and, while they were in power, the ANDP celebrated new private sites opening, and they did smiling photo ops with the executives of these companies. People like — although not precisely — Doug Mills, or the Chartwell named executive officers who are getting $6,000,000 paid out to them.

Trevor: And while they were in opposition, you might have been fooled into thinking they might have done good things when they got elected because they were regular fixtures at continuing care strikes and rallies — there was a period, from 2012 to 2014, where hundreds of continuing care workers ended up on strike and improved their contract — but guess what? After getting electing, the knives were out and the Alberta NDP stabbed the Cold Lake, Points West Living workers in the back. They were preparing for a strike in September in 2016 — the employer came to them and said, “No, no, no, we need more time,” and that was to allow them to train more scabs and, in their infinite wisdom, the Alberta NDP said, “Yes, employer, we would like to help you with this problem. We will intervene to stop the workers from going on strike.” And this allowed the company to, instead, lock out their staff before Christmas. Thanks, Notley. During this strike — or, rather, during the lockout — NDP MLAs were actually told not to visit the picketing workers; and that did end up being divisive within caucus, but, at the end of the day, that was what happened. I don’t know if you could put yourself in this situation, thinking that you’re in a social democratic party and being told not to walk a picket line with workers. So, no thanks to the government, the workers stuck it out and won improvements to their contracts anyways.

Kate: Cold Lake Points West Living workers are so much braver than the troops. It’s not even fucking close.

Trevor: Fuck yeah. Mad props to Cold Lake.

Joel: Yeah, and I’ve heard that Cold Lake, in the winter, is cold. Is this true?

Kate: It is extremely fucking cold in Cold Lake in the winter. Trevor, how long were they locked out for? It was a very long dispute.


Trevor: I think it was about six months, right? And so they went from absolutely freezing — I think, like, -40 with windchill — huddled around a propane heater kind of picket line, through to the spring thaw and even hotter weather out on that picket line. And, again, it takes a lot of guts to do that, and hats off to those workers who did not have their government or their employer, clearly, on their side in that.


Kate: Absolutely. And, in case you were thinking, “Wow, this story about the Alberta NDP sounds really awful. I can’t believe they would do that,” it turns out they actually found another knife to stick in the backs of workers in continuing care and, in 2017, they actually changed labour laws to restrict strikes in continuing care. So, despite the success of this 2012-2014 strike wave, under labour law, that had continuing care workers equal to most other Alberta workers in terms of their ability to strike, the Alberta NDP put this extremely bureaucratic essential services negotiations on continuing care, and they basically act as a barrier to strikes in private homes by forcing workers to negotiate extremely unwieldy essential services agreements that, basically, make it impossible to get into a legal strike position in a way that will be effective in any way against your employer. So, they have essentially made strikes illegal in a real-term way for private continuing care workers. And labour academics have speculated that these restrictions on striking could be a recipe for wildcat strikes, or unauthorized strikes.

Joel: Okay. So, Points West is making it on the list. Who is next?

Trevor: Okay. Well, these folks have been in the news: Retirement Concepts. They’re BC-based, but they operate two homes in Calgary — and, if I say Mill Rise Place, you might have heard that — as well as Monterey Place; both, unfortunately, experiencing outbreaks right now. So, they were a BC-based company that were sold to Anbang Insurance, a multi-billion dollar international insurance firm. Their chairman was then brought under fraud investigation and taken over by the Chinese government, who have now shifted what they call the non-toxic assets to a new multi-billion dollar insurance firm called called — I hope I’m saying this right — Dajia Insurance. So, hooray. That’s great. And then, prior to the pandemic, four of their homes in BC had their operations taken over by the government because of concerns about care delivery. Then the outbreak happened at Mill Rise, there was concern over management of care here in Alberta, and the government, instead of having Alberta Health Services step in and take over, decided that another for-profit company should benefit off of this crisis, and they let AgeCare come in and take over the operation of Mill Rise place.

Kate: And AgeCare, you’re going to want to put them on the list, too, Joel. They’re another private continuing care operator — they operate 11 facilities, 10 of which are in Alberta. Both the corporation and the founders are longtime conservative donors. They are also no strangers to labour dispute — in Medicine Hat in 2008, there was a strike over unequal pay and, according to Friends of Medicare, AgeCare has received over $23,000,000 in government grants, some of which, I assume, they are siphoning off the top and giving to conservative donors, which is great, and I’m not mad about it at all. Just about all of these private operators, including AgeCare, have spent money that they get from the public and their residents on political donations. So, it’s not just AgeCare — a lot of it is to the Liberals in British Columbia, the former PCs in Alberta, and a mix of the Liberals and the PCs in Ontario, and a small but noticeable amount of that money actually ended up in the hands of these provincial NDP sections as well. And again, of course, I’m hoping that all seven of the Canadian Taxpayers Federation members listening in on this are really jumping on this abuse of public taxpayer money.

Trevor: I’m going to hold my breath and wait for that to happen.

Kate: [laughs]

Joel: Yeah, I’m sure they’re listening and will definitely take action as soon as they hear this. Okay. So, I’ve got a good little list here. What about the people that actually work in these long-term care facilities? What are conditions like for workers there and for the people in that care? What is it like to work there?

Kate: So, the people who are providing care are overwhelmingly low-wage racialized and feminized workers. A demographic study of Alberta licensed practical nurses and healthcare aides that was done in 2018 shows that these workers are overwhelmingly women — so, over 90% of continuing care workers are women. Only a third of them are English as first language speakers — so, a really large migrant workforce — and only 47% of them work full-time. So, it is highly racialized and highly gendered as a form of labour. And, really, what is happening here is: we are importing care from other countries. Another really awful thing that happens in this process is: we don’t (and, by “we,” I mean Canada) don’t recognize the credentials of healthcare workers that immigrate to Canada often, so many healthcare workers in continuing care might be trained as registered nurses or as dentists or as doctors, but, in Alberta, they work as licensed practical workers or healthcare aides, which require less time to get your credentials for, because Canada does not recognize their credentials because of racism and imperialism. And it’s really important to emphasize both the gendered nature of care work and, also, the racialization of the workforce because continuing care workers are so often blamed, when things go wrong in continuing care, for things that are totally out of their control. When continuing care workers can’t provide appropriate care, media often focuses on these really sensational stories, which do happen, of workers being really cruel to residents in some way, or abusing them in some way, but the truth is that the vast majority of inappropriate and inadequate levels of care that exist in our continuing care system are because of short staffing and these places not being staffed appropriately to provide the amounts of care that our seniors and our elderly deserve. And this happens because the work that these largely-women, largely-immigrant workforce performs is not seen as valuable, and it is a huge concern of mine that, because COVID-19 is making the failures of our continuing care system so apparent, what will happen is that the workforce will be blamed for something that is completely beyond their control when they are doing their being dealt an incredibly, incredibly short hand, and that the blame won’t fall on the people that it should, which are all the awful motherfuckers that Trevor and I just described.

Trevor: Amen. So, because we live in a society, it’s probably good to focus not just on individuals, but on systems, and the Parkland Institute looked at some of the conditions in care homes and the care provided in the study we’ve talked about in 2016, “Losing Ground.” Their research says we should be providing a minimum of 4.1 hours of direct care per resident per day — as a minimum — to maintain health. Now, that standard is a bit older — patients now are a little bit sicker, they have higher acuity, so we actually probably need to provide more than just that 4.1 hours, but that may be the best research we have right now. So, how does Alberta care homes measure up with that? In the public sector, they’re falling just a little bit short — they’re providing 4.0 hours on average. But then, you look at the private sector, and surprise — it’s much worse. In a for-profit home, the average is only 3.1 hours of care. So, to be clear, you can’t pay your way to better care in the private sector in Alberta. How does the not-for-profit sector stack up there? They’re even six minutes short from the for-profit sector at 3.0 hours. And why is that? A possible explanation: the not-for-profit providers are spending more on administration than the public, and even the for-profit, providers, which means less invested in frontline care. Some of these are smaller than some of these for-profit providers, and maybe that’s an explanation. But, in any case, this is bad for resident care. It means the staff experience — they are overworked, they are stressed out about not being able to meet people’s needs.

Kate: So, this morning, I read that new research by the Toronto Star found that seniors living in for-profit care homes are four times more likely to die from COVID-19 than seniors living in public homes. So, it is an astonishing gap between the public sector and the private sector in terms of the quality of care that these residents are receiving, and even then, the public sector is still falling short because of things like disinvestment from the public healthcare system, short staffing, all those kind of things. And another really important piece of the puzzle, when it comes to working conditions in long-term care, is that many staff are working two, or even three, jobs to pay the bills. And, even before there was a pandemic, this was a big concern — if there’s a flu outbreak, you can spread that really easily if you have staff who are working multiple facilities. And this is one of those things, to me, that just really is emblematic of the fact that this is not a well-designed system, that our society sat down and we were like, “We have to take care of the elderly. What should this system look like?” and this is what we came up with. Because, if you gave staff the hours, they could stay at one facility, and you paid them properly, so they didn’t have to work more than full-time hours. But the truth is that these providers don’t want to a) pay people appropriate wages, and they also don’t want to give people full-time hours because they don’t want to pay the benefits you have to pay for full-time workers. So, it’s led to this incredibly piecemeal system that is really unpleasant for workers to experience but is also really dangerous for residents who are living in continuing care.

Trevor: And it’s really a sign, as we talked about, about: how do we value the elderly in our society? And, under capitalism, these are people who are no longer, often, in the workforce, especially if you’re in long-term care at that age, so you can’t make a profit for anyone, and so guess what? We’re just going to leave you to warehouses and pay people nothing to take care of you.

Joel: Just a detail that I think is important to bring attention to when we’re discussing this — in particular, the minimum hours of direct care per resident — there are 24 hours in a day. You’re sleeping maybe eight of those. And this is the number of hours per day that someone is actually paying attention to you, right?

Trevor: So, these are people in facilities with complex health needs. This can often be physical, but mental health issues, as well. So, you need to meet people’s physical needs, but there’s also — in good care settings — a lot of emphasis paid to the relationships that caregivers have with these residents and patients to maintain their well-being, which we’ll touch on later.

Kate: And one thing I’ll say is that, if you talk to continuing care workers and you ask them, “If you had a magic wand, what is one thing you would change about your job?”, overwhelmingly, people say, “We need more staff so I can actually the care that I was trained to do.” And you do hear really heartbreaking stories of, these are people who want to provide appropriate care for residents, who were trained to provide appropriate, standardized levels of care, and are being placed in situations by these employers where they are physically unable to do so within the confines of their job. And I think something that doesn’t get said enough is how incredibly dificult that is for the people who are providing that care, to know that what they are doing is inadequate and not how they would like to care for another person, and to be unable to have the control over their workplaces to do anything about it is profoundly upsetting to me.

Trevor: Absolutely. It means that these people are taking this home with them — the day doesn’t end when they clock out because they’re going home, sitting down to dinner, and thinking about that one resident that they didn’t get to take to their meal on time that day, or some of the other challenges they’re facing. And I think the dedication of these workers really highlights, to me, just how bad things can get in some of these facilities that would push these workers to end up on a picket line, because that is not a decision any of them take lightly — it is very tough to be out there when the residents are inside, but, ultimately, what they are doing in improving their working conditions, they are improving the conditions of care for their residents, and I think that’s why you see them sometimes taking that step.

Kate: Yeah, working conditions are care conditions in continuing care, and one of the things that I think about, too, is how the care and dedication that these workers have for residents is also used by management, and by these employers, to actually erode their working conditions, because it’s really tempting — and this is a natural, human response — if you care about your job, and your job is caring for other people, to maybe miss the first five minutes of your break because you really need to help someone, or to do a couple of extra things after you clock out, or all of these types of thing. So, this system that we have encourages workers to erode their own working conditions by preying on what are good things that we should encourage in continuing care workers, like empathy and compassion.

Joel: Alright, so we’ve heard a lot about how the COVID-19 outbreak has exposed various parts of our society that were dysfunctional in the first place or were under immense stress in the first place. How has the COVID-19 outbreak highlighted the dysfunctions within long-term care?

Trevor: So, right now, there have been over 30 outbreaks in continuing care centres in Alberta, and the majority are those are happening in the for-profit sector. You can measure that by the number of sites, the number of beds, and — unfortunately — the number of deaths happening. The private sector is clearly failing in its pandemic response, and a lot of this data is not provided by our government, so, again, shout-out to independent researchers like Nora Loreto on that. We have to dig this us ourselves to find out what’s going on. We’ve talked about this, how this ended up getting here; there are people making just above minimum wage in some of these facilities — they don’t like providing full-time hours, so people have to work two or three jobs just to get by. You hear stories about things like workers being told, “Oh, just wear a dust mask and that’ll protect you from COVID. Things are going to be fine.” Real attention to detail from some of these people.

Kate: And our government’s response has been completely and totally inadequate. So, the government announced that they would be ordering workers to work at a single site in order to halt the spread of COVID-19. The unions that represent workers in continuing care pushed them to top up hours for people who work part-time and are losing hours as a result of this. The order, however, had no implementation date, so it’s extremely unclear if all the providers are now doing this; and, like many things in continuing care, it’s led to this really piecemeal system that’s prevented us from having a robust response to crises like COVID-19. The other issue with this order is that it limits workers to only one continuing care site, but not only one job. So if I was, say, a housekeeper for Carewest and I also worked at Safeway, I am still allowed to do both of those jobs, which, obviously, is an incredible risk for my coworkers, the residents, and the public in general. On April 20th, they also announced that healthcare aides were going to get a $2/hr raise. They clarified it, saying, “Screw you” to the workers in the public sector — only workers in the private sector deserve recognition. Extremely “???” energy. As of this recording, there does not appear to be a single worker who has actually got this raise. There’s a lot of details flying around about it, but apparently the government has been so stingy on details with these employers that they can’t even figure it out; and, as of this recording, absolutely jack shit has happened. And, even with that $2 raise, there will still be healthcare aides being paid less in some private centres than they would make in the public sector. And it’s not like the pay in the public sector is amazing — the top rate is around $25/hr for a healthcare aide in the public sector, so it’s not like these workers are raking in the dough. And what’s really egregious about it is when you compare this to other provinces; in Quebec, they said that all healthcare workers deserve a raise — $4/hr in private care and $4-$8 in the public sector, and, in Doug Ford’s Ontario, they said everyone, public and private, deserves an extra $4/hr.

Trevor: And in Spain, their government said, “You know what? Nationalize it,” something people are already calling for in Alberta. Over the Rockies, BC took a pretty strong response — the public sector is now running all the staffing in all the facilities, and all of those workers have had their wages topped up to be equal with the public sector, which may be as much as $7/hr more in some places. So, shame on those people. Joel, we’ll get you names; we can put them on the list.

Kate: [laughs]

Joel: Perfect, thank you.

Trevor: And, by taking that kind of action, these measures have helped BC reduce the rate of death in their long-term care centres. They’ve said these measures are temporary right now, but I know workers and unions are already talking about, “Let’s improve the system — not just during the pandemic, but after — and make these changes permanent.”

Kate: And Alberta still doesn’t have centralized staffing — even though we’re, what, two months into a pandemic? — and we really see the impacts of a fractured system earlier in the pandemic when Alberta Health Services had to take over operations of Manoir Du Lac in McLennan, which is a rural town in northern Alberta. They didn’t have a for-profit friend to hand over the facility to there, and because they were a smaller private provider, they didn’t have the resources of Alberta Health Services, or even some of the larger for-profit chains to help with their issues and help with their response, and I think this, and the other patchwork of continuing care, really shows to me the importance of planning and the importance of economies of scale, is — even if, in some magical world where capitalism was working and you had the best, most generous, most wonderful private continuing care operator in the world, but they only operated one continuing care home in rural Alberta, they are always going to struggle as compared to a robust public system that has the resources of the entire public healthcare system and the resources to have purchase orders and centralized staffing at these large levels. And the importance of that, I think, goes for all of the times to make the system as robust as possible, but especially in a pandemic, when you need flexibility and slack in these systems. Having this patchwork quilt, or this piecemeal system, of continuing care operators just means that a lot of people right now — workers and residents — are falling through the cracks.

Trevor: Yeah. One story I’ve heard about the pandemic response and the strain it’s putting on the system is the need for screening staff, or even the rare visitor that may be allowed. In Alberta Health Services right now, they’ve put a pause on a lot of elective surgeries, and they’ve allowed that slack in the system, which frees up some staff to do some of that screening. As you could imagine, in a long-term care centre, there isn’t anything they’ve stopped doing since the pandemic, so any important — in the central screening that they’re doing for possible COVID-infected staff or others coming in to the facility — means that they’re either taking away from staff that should be providing care or they’re just adding to the already over-worked duties of some of these staff who, maybe, are coming into work on their days off to do that kind of thing.

Joel: Alright. So, it sounds like long-term care is bad. Is that a fair conclusion?

Kate: More and more people are saying that, yes.

Joel: So, let’s go to the fun part, which is, okay: given these bad conditions, what changes should be made? How could we make a good long-term care system, and what should it look like? Who should fund it, and what would be involved in it?

Kate: It has to be public.

Trevor: Yup.

Kate: That is the base of all of this. It has to be public, and that means no not-for-profits, either. And the reason it has to be public is because making profit off of caring for elders and our sick is immoral. It is immoral to make money off of doing that — that is something I really firmly and deeply believe, and I do not think that, in a just, moral society, you should be able to do that. And the solution to that is running it publicly. The other reason is that publicly funding for-profit services is incredibly inefficient. We can just do it ourselves.

Trevor: And not-for-profit also means that they can opt out of things like medical assistance in dying, and there can be concerns with providers delivering care respective of gender and sexual orientation, including in some of the faith-based settings. That doesn’t mean that the public sector is perfect there — there is work to be done on providing good gender-affirming care and care spaces that are friendly for all of us. And there may be something to be said for providing care that is responsive to people’s faith, as well, but we can do that in the public system. We’ve had chaplains in our hospital — there’s no reason why we can’t do that in a long-term care or assistive living centre.

Kate: And better models for workers and residents. A really interesting example is: in many of the Nordic countries, long-term care workers have more say about their work, and, in fact, the workers there actually design the schedules, so it is a democratic process. And then, also, it’s not only good because it brings democracy into the workplace and it gives workers control over their workplaces, it’s also that the fact of the matter is that the people who care for the residents every single day have a way better and more accurate idea of the actual staffing needs of these workplaces than an administrator or a scheduling expert. They are going to design a schedule that provides better care because workers are the experts — workers run the world, and they are the experts on those workplaces. So, I think that is a really important part of it. And, also, staff in those settings, they have more time for things like sitting down and having a coffee with a resident, or often they will run errands with them, things like that. And that is so much better for not only the mental health of residents, but also of workers, and it is also a much more relational model when it comes to providing care, and I think that is something that our sick and our elderly deserve.

Trevor: I don’t know if you’ve seen this, but in Ontario, UNIFOR is doing this six-minute challenge, or this eight-minute challenge, and it’s based on the amount of time that workers are given to get residents up, out of bed, and into the dining room for their breakfast. So, I don’t know about your morning routine, but I don’t think I could do that in six or eight minutes or whatever.

Kate: Yeah, and I’m a young, able-bodied person with no health concerns, and I would truly struggle to get out of bed, get dressed, and get to a meal in six minutes from waking up. I also think another really important thing, when we’re looking at what continuing care would look like, is that we have to start valuing this work. Caring for our elders is socially important, valuable work — it is some of the work that is the backbone of our society, and people who provide it should be treated with a great deal of respect. And, like Trevor said earlier, what we have right now is really representative of how we treat our elders and how we treat people who can, writ large, no longer participate in the workforces. Our society doesn’t value them, and that means we don’t value the people who care for them. So, I think a different imaginary of continuing care would have to say: people who can’t work, because they are elderly, because they have complex care needs, are still valuable and are still part of our society, and that means people who provide care for them are valuable, too, and the work that they do is important.

Trevor: And I think another aspect of this that needs to be recognized: not everyone ends up with, maybe, their parents or their grandparents in the continuing care system — especially long-term care, where it’s more complex needs — but this often isn’t something that you can just do for your parents when they get older. This does require specialized skills to recognize the illnesses that people have and to provide that sensitive relationship-based care that can be very, very difficult for someone who is managing the stresses of a full-time job. And so, this shouldn’t be seen as sad and unfortunate, as it sometimes can be — and it is when it’s not adequate — but yeah, you’re right. This is socially valuable work that needs to be done.

Kate: The truth is, we come into this world relying on other people to take care of us, and a lot of us are going to leave this world relying on other people to take care of us, and there is, as Trevor says, a lot of shame based on the idea that the family should be able to provide for all of these care needs and that you are somehow failing, as a child of your parents, if you are unable to provide this care for them, has really got to go. So, I think normalizing needing complex care in this way is a really important part of how we would think about continuing care in a more just society.

Trevor: So, I think another thing we need to look at is actually meeting the needs of an aging population in Alberta. We’ve been undergoing this privatization experiment for decades now under many promises, and one of them is that the market will make sure that there’s enough spaces for all of these people, we just have to get out of their way while also handing over buckets of money to them. But it hasn’t worked out that way — shock! Surprise! We still have massive waiting lists. We still have people occupying hospital beds who are waiting to be placed in continuing care facilities, and that means people who need hospital care are prevented from getting that.

Kate: And that goes back to what we were saying about the private system being inefficient, is: if you really care about costs, it is way more expensive to keep someone in a rural acute care hospital bed than to put someone into a long-term care facility. And, because we do not have enough capacity in our continuing care system — once again, because it is treated as real estate, which makes me just want to punch a brick wall — we have this incredibly inefficient system that is more expensive than it would otherwise be. And the reason that this — treating continuing care as real estate — matters is that, when you treat something as real estate, you want to have a tight market to ensure that you always have artificial scarcity and that prices stay high — and that, to me, is not how we should be providing care. I don’t want people to be creating artificial scarcities of care in order to line their pockets and to hand out money to shareholders. Once again, I think I think that is immoral.

Trevor: This highlights, instead of leaving this all up to the market, we need to plan for our future needs; and who greater an advocate for a planned economy than the Conference Board of Canada? They put out a study in 2017 on long-term care called “Sizing Up the Challenge,” and they said, by 2035, Canada needs to build 199,000 new long-term care beds. That’s almost double what we have now. So, if we want to figure some of this out in Alberta — we’ve got 12% of Canada’s population, maybe that’s 20,000-some beds. They say it’s going to cost maybe $321,000 to build a bed, so you could say somewhere $6,000,000,000, $7,000,000,000 — maybe more because of costs in Alberta.

Kate: So, I did some back-of-the-napkin math based on the staffing ratios that are recommended in this report and that are fairly standard, and this would create 12,362 in Alberta alone. These are jobs that would be low-carbon, green jobs, that would be in care work, and they would be jobs that, traditionally, employ people which are excluded from the labour force, and they would be jobs that are often union jobs. And, since our government cares so much about jobs — which is why I’ve been told that they’re always purchasing these extremely expensive pipelines — I thought it would be really interesting to see what the bang for our buck is in terms of public investment versus the number of permanent jobs you get out of it when it comes to continuing care, and then when it comes to something like pipelines. So, the Trans-Mountain expansion is $4,500,000,000, plus there seems to be an ever-growing list of these wild, ballooning costs. It is going to create around 100 non-union permanent jobs — lmao — plus a couple thousand in construction that will be temporary for two years. So, TMX, without calculating these ballooning costs — using the 4,500,000,000 number — is $45,000,000 per permanent job, and building long-term care beds — which we need — is $566,000 per permanent job at the higher number, the higher price estimate, of 7,000,000,000. So, this means that the government is subsidizing jobs in pipelines 80 times more than they are subsidizing jobs in long-term care. 80 times. It is absolutely inefficient and ridiculous, if creating jobs is really your purpose, to go about it in this way. And, of course, the reason the government buys pipelines is not because they are actually interested in created jobs, but I really think, when you look at the two workforces in those two industries, you see who the government really considers to be people who are deserving of employment and who are deserving of help from the government, and it isn’t the primarily low-wage, racialized, and gendered long-term care workforce. I mean, we’re talking about six to seven billion dollars to build these LTC beds that we need in Alberta. Jason Kenney literally recently spent $7,500,000,000 on the famously evil Keystone XL pipeline, which is mostly not in Alberta, so he literally blew the entire amount of money we would need for this project on a pipeline that is, once again, famously evil.

Trevor: Kate, do you think we could get Rachel Notley and Jason Kenney to care more about building public, long-term care spaces if we called them a pipeline for seniors?

Kate: [laughs] I’m putting my seniors in the continuing care pipeline. Absolutely. I think that would really work.

[laughter]

Trevor: Okay. We need to get our elderly to Tidewater.

[laughter]

Joel: Yeah. All the facilities will be shaped cylindrically now.

[laughter]

Kate: God, it makes me so mad. Oh my god.

Joel: What’s especially gross about what you two just talked about now is the idea of: if this doesn’t happen, if this important public investment does not happen, you’re going to end up in a situation where the market gets to dictate what gets built, and it’s going to reinforce this already-existing artificial scarcity, and you’re going to have liquidating their parents’ assets, trying to outbid each other to get their parents in care, is basically the scenario that is being set up.

Kate: And people will die in in unnecessary pain. That is really what we are talking about here — people will not receive the care they need to end their lives with dignity. And that is so abhorrent when I think about my own parents, or my grandparents, or I think about what I hope for myself as I age — I hope to be treated with dignity and respect as I end my life — and knowing that, without this happening, that is not going to be a possibility for the vast majority of people unless they are very lucky or very wealthy, is very upsetting.

Joel: So, this all sounds good as far as envisioning a long-term care system that we would actually want to have in our society. How might we actually get there? Or, in other words, what is to be done?

Kate: First off, we need to stop privatization dead in its tracks through strikes. So, Jason Kenney payed Ernst & Young $2,000,000 to recommend a whole slew of healthcare cuts which include selling off thousands of public long-term care spaces, starting with Edmonton and Calgary — this is Capital Care and Carewest. I think, realistically, we need to think about what would force the government to back down on something like that, and I think large-scale labour action, or a willingness to participate in large-scale job action, is what we’re looking at in terms of the leverage acquired to stop a government as ideologically motivated as Kenney.

Trevor: Mhm. So, yeah — we have to stop that privatization, and I don’t know anyone who would be looking at the private sector’s failure to respond to this pandemic and say we need more of that. Or, rather, I should say I don’t know anyone outside of the UCP caucus, anyways, because you know what? I bet you if people don’t really push back, that’s exactly what they’ll do when this is over. But even then, the private sector is still going to be around, and so there really is leverage in the workplace, and workers have a lot to do to make private continuing care as unprofitable as possible. And, so, that means negotiating an equal playing field with their fellow workers in the public sector who have better wages, who have decent pensions and these sorts of things and, when push come to shove, the only way they’re going to get there is through strikes.

Kate: And the reason that there’s so much leverage in the workforce within continuing care specifically is that, when you make a private company in continuing care unprofitable — when you run them out of your province or your country through labour action, through organizing, through strikes — it’s not like it’s a factory producing tchotchkes, right? Those people still need to be provided with care, and you can basically force governments into assuming control of these private continuing care facilities through making them unprofitable, and you can force governments to take up a larger share of the market when it comes to continuing care. One thing I would not recommend, as far as what is to be done, is electing a new government — tried that, didn’t work — but, if any politicians listening to this podcast would like some suggestions (which, of course, you will ignore when you do get elected), better regulation on staffing levels, safe staffing ratios, and transparency. Let’s let the public see how much we give these motherfuckers, how much they profit, and we should tie 100% of funding to delivery of care so they cannot use the money that is intended for the wages of healthcare aides and licensed practical nurses to line the pockets of their shareholders.

Trevor: Yup. And we’ve talked about this — we’ve literally handed over millions, hundreds of millions of dollars, to these providers to open these facilities, to give them more real estate assets, and then, over the years, millions and millions more to provide this care, so guess what? That’s our down payment for these facilities. Let’s take them back. They are ours — we should own them, and we can run them better.

Kate: We have already paid for them. And that goes back to the other thing about making private long-term care unprofitable — if, for some reason, you’re a wacky social democrat who is not okay with expropriating things (probably because expropriation is very cruel and you’re not), consider that making these companies unprofitable is also a way of making them affordable for governments to purchase back — if you are, once again, a coward and do not just simply take them from these people. The other thing, too, is that we subsidize long-term care in another way because long-term care and designated supportive living basically rely, really heavily, on the public sector as soon as there is a problem that their infrastructure can’t handle. And what happens is that, oftentimes, more complex care gets passed off to the public sector, making it appear more inefficient, while these private corporations and providers basically skim easier and less complex cases off the top. So it is really a double whammy in terms of the subsidization that we have pried to continuing care.

Trevor: There is talk of what to do about this on a national level. We have the Canada Health Act that is an inadequate, but good, piece of legislation for providing things like hospital care for Canadians, and so people have said, “Let’s create a national law around long-term care that is similar to that which would provide funding from the federal government to the provinces with strings attached. If you want to keep getting this funding, you have to provide adequate, universal long-term care services.” People have said, “Hey, let’s not open the Canada Health Act because we shouldn’t trust people like Justin Trudeau or Peter MacKay or — I don’t know if Bryan Adams is going to be the Conservative Party leader — they’re just going to make it worse.” We also saw not full-on nationalization, but improvements made, in British Columbia in the 1990s. What they did there is: they standardized bargaining and pay — they made all the private providers come to the same table, and all the unions came together in the same table, and they said this would standardize the pay, leading to equality among workers, better benefits and pensions for the people who are providing this important care, more investment in the system. And those unions fought for, and won, language against contracting out, so you had a stable labour force to build relationships with the patients.

Kate: Unfortunately, the BC Liberals did tear this completely apart after getting elected. Sectoral bargaining became optional, and now, over 42% of facilities are outside the system. And Kenney actually campaigned for the BC Liberals — they also legislated tearing up healthcare workers’ contracts so they could contract out work to avoid the union, which led to cases like one facility going through six different rounds of contracting out in thirteen years and a 28% pay gap for healthcare aides at that site. And what this really illustrates, to me, is something we’ve talked about on the podcast a ton, which is the importance of making any kind of policy changes that exist in government as powerful, and as rigorous, and as hard to undo as possible — so, instead of saying, “We’re standardizing bargaining and pay,” is literally taking these things from private companies — and, also, the importance of having real power on these worksites to actually enforce these demands because, if it’s so top-down that it can be undone by a change in government, you’re not actually operating from a position of strength, rather than if it’s something that’s won from struggle from the shop floor, these continuing care work sites, it’s going to have a lot more durability because those people are going to be willing to engage in struggle if those things are going to be attempted to be taken away from them.

Trevor: And it should be pointed out — not only did Kenney go and campaign for those BC Liberals, but there have been staffers from that ghoulish government coming here to work for the Kenney government, so I’m sure they are looking at the model of fucking over workers and patients as something to emulate here in Alberta, and we have to be prepared to fight it.

Kate: Absolutely. Another really powerful place, when it comes to winning any of these demands that we’ve talked about in continuing care, is solidarity between residents and workers. On this podcast, we’ve attempted to talk about them as two groups of people who are taken advantage of by one system and by these employers, but that’s not always how residents or workers actually tend to see these things, and I think using things like resident family councils to create solidarity between these two groups is really important. So, one of the really significant barriers that exists to creating solidarity between residents and workers is that we live in a society that perpetuates racism, and we live in a society that, through that perpetuation of racism, really devalues, in a systemic way, the work of people who provide care. And this is a really big barrier to get over when it comes to residents actually being able to form meaningful bonds of solidarity with workers where they are using their political power that they have within the system to advocate for those workers and to advocate for a stronger system overall, because the work that is done is so devalued, and is so devalued because the workforce is gendered and racialized, that it is a huge barrier to actually creating meaningful solidarity. Something that we can also think about here is that it’s not an either-or when it comes to working conditions and care conditions in the public sector versus the private sector because, so often, what is bargained for in the public sector in terms of wages, staffing ratios, pensions, etc, does end up trickling down to private healthcare, and it is these public sector collective bargaining agreements that private continuing care operators base their agreements off of — after cutting a bunch of things here and there. But it is virtually unheard of for private care to negotiate something that is better than exists in the public healthcare system, so public healthcare has a really important role to play in, basically, setting these standards through which we can measure private continuing care, too.

Joel: Wow. You two did a really great job with the research for this episode — thank you both so much for dropping all that knowledge on me. If out listeners walk away from this episode with a few key, core facts, what would you want those core facts to be?

Trevor: Well, I think it’s worth recognizing that shit sucks, right?

Joel: Indeed it does.

Trevor: But, even in Alberta, workers have taken on these private providers and they have won, and we need to be mindful of that — when we see protests, strikes at these facilities, everybody out, let’s support them. And we also know that we have allies out there: groups like Public Interest Alberta, Friends of Medicare, building off research done at places like the Parkland Institute to highlight these problems because we need to fix them.

Kate: When we fight, we win, and I think we have a moral imperative to improve this really, truly god-awful system that exists. Continuing care in Alberta, to me, is a really great example of how the profit motive has just warped something that is fundamental and necessary to a good society and made it so incredibly cruel and so incredibly incapable of responding to the needs of people, and I also think continuing care is a really great example of these intersecting crises that exist in capitalism. It’s not only the crisis of COVID-19, but it’s also the crisis of how we devalue the work that is done by women and done by racialized people. It is the crisis of imperialism in the way we import care from other countries and then don’t recognize these workers’ credentials or their abilities to provide care. And, overall, continuing care, how is exists right now, it is a terrible way to treat people. It is astonishingly, astonishingly cruel and, if we want to live in a society that is good and just, and in a society that you and I would feel comfortable growing old in, we have to change the system of continuing care as it exists. It is something that must be done. So, on behalf of everyone here at The Alberta Advantage, I hope this was an interesting an illuminating episode when it comes to taking more of a structural look at the issues in continuing care and how they’re being impacted by COVID-19. Stay safe and stay healthy out there. Bye bye!

All: Bye!

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Kate: The Alberta Advantage is part of a loose affiliation of left-wing podcasts hosted by the bilingual journalism collective Ricochet, who you can find at ricochet.media. Our podcast is primarily supported through Patreon by listeners like you. We use the money for equipment and other semi-serious pursuits and, as a thank you, we send out fun packages with grain elevator-themed stickers and weird tote bags a couple times a year. You can support us at patreon.com/albertaadvantage. Thanks so much for listening, and take care out there.

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