A Conversation With James Gordon: Part One, Long Term Care Facilities

I've recently acquired the technology to make broadcast quality recordings and taught myself the rudiments of audio editing. As a result, I'm going to stop going through the tremendously tedious process of creating transcripts of interviews and simply include sound files in the body of the text of blog posts. Just click on the hypertext link in the question and you should be redirected to a Google Drive page where you can listen. (Please give me feedback if there is problem listening to the files---I'm on a learning curve. You can email me at thecloudwalkingowl@gmail.com .)

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In this post I'm having a conversation with Councilor James Gordon, from Ward Two. I have a pretty good rapport with Gordon, who I first met in 1988 when I ran for Parliament under the Green Party ticket. For those of you who don't know, his main claim to fame is that he's an accomplished musician. That's how I first met him. My campaign staff were making a video for community cable tv (remember when that was a thing?), and they wanted to use one of his songs in it.

James Gordon wearing cowboy garb.
Photo provided by him.

We had a good talk and raised what I think are a variety of pretty important issues that "hover in the background" of our community. I hope that you like what follows.

How has the pandemic affected your job as a city Councillor? 

I think that what James has to say raises some pretty important questions about how a democracy is supposed to act, both in and outside of public emergencies like a pandemic.

Handing over control of the city to an committee of senior staff members and public health officials seems like the right call because they need to make fast, informed decisions and can't wait until Council makes up it's mind. There's also an issue in that politicians often make decisions based up ideology instead of evidence, which can lead to catastrophic mistakes. (Look South of the boarder to see how well that works---.)

That leaves an elected official doing "constituency work", which James describes as "referring" people to the various local government agencies to deal with their problems. This transition from doing the job of directing the policies and long-term goals of the city to simply being the "middle-man" between citizens and the bureaucracy is an endemic issue on all three levels of government: federal, provincial, and, municipal. The democratic think tank "Samara" did a series of exit interviews with MPs in 2009 and 2010 and came up with a surprising result: many elected officials are extremely upset with the amount of time they spend "politicking" and finding "workarounds" for constituents having problems with the bureaucracy. Primarily this isn't because they don't like meeting with voters, but because it eats up so much of their time that they don't have time to put into what their primary job really should be: researching and creating good government policy.

1. Constituency work in its present form is too often weakly connected to MPs’ parliamentary work, and can hinder, rather than enhance, MPs’ focus on legislation and Government spending.
2. There are better ways of helping citizens, such as by systematically addressing problems in public services, rather than creating workarounds on the individual level.
3. There are better ways of representing citizens, such as by making innovative consultation founded on public learning the central focus of constituency work. (Beyond the Barbecue) 

More about this in the following conversations.

Why do governments always seem to wait until a terrible scandal happens before they will fix any problem brought to their attention?

I made a couple mistakes in this part of the conversation. First of all, I referred to the Wettlaufer murders as being "mercy killings". When I looked at the Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System (commonly called "the Wettlaufer report"), it starts off making a very strong statement that they most specifically were not "mercy killings".

---Wettlaufer herself has not suggested that she killed out of a sense of mercy. By her own admission, she committed the Offences because she felt angry about her career, her responsibilities, and her life in general. There was no mention of feelings of pity or concern for the victims. She felt “euphoric” after killing. Wettlaufer committed these crimes for her gratification alone, and not out of some misguided sense of mercy. 

Secondly, I suggested that private senior care homes made $1.5 billion in profits last year according to a Toronto Star article. What the article says instead is that three of the largest privately-run nursing home operators in Ontario made $1.5 billion in profits over the last ten years. It also adds in "executive compensation", (which no doubt involves bonuses and stock options beyond basic salary), and share buy-backs (which is a way of artificially propping up share price, which translates into profits for executives who are given stock options---which means that they get payment as a capital gain---which I believe lowers the amount of income tax they have to pay). This adds up to $1.7 billion over ten years, or $170 million on average per year.

Unfortunately, this is a game that reporters and politicians routinely play where they don't give the yearly figure but rather compound it over a period of time so it looks larger. The really important number would be to come up with a figure per resident per year. 

Extendicare, Chartwell and Sienna are among the biggest players in Ontario’s long-term-care industry, operating 140 long-term-care homes with more than 19,000 beds in the province.

If we were to just divide that $170 million by 19,000 we'd come up with a almost $9,000/per patient/year. That's obviously wrong, as the money is clearly for the entire corporation. All three operate in other provinces and I suspect Extendicare also operates in the USA (language can be vague at certain websites.) Obviously, just throwing around large figures doesn't really do anything except get naive readers hot under the collar. (Unfortunately, in politics and much of the "legacy media" this "isn't a bug---it's a feature".)

I wasn't able to find enough info to break things down to the amount of profit/patient. What I could find, however, were graphs (c/o the TMX Group website) that show how well the stock of all three companies have done over the past ten years on the Toronto Stock Exchange. The year is on the bottom of each graph with the price of an individual share on the right. Please note the "dip" at the end of each chart as the Corona plague struck and revealed problems in this investor's paradise.

Chartwell

Extendicare

Sienna

Now let's see what the composite index of the Toronto Stock Exchange looks like over the last ten years.

Toronto Stock Exchange Composite Index

As you can see, it appears that Sienna and Chartwell seem to have beat the average in stock gains, whereas Extendicare seems to have done worse. The difference doesn't seem huge, however, which would seem to me to indicate that running seniors and long-care homes isn't a lot more profitable than anything else. And in turn that would suggest that not a huge amount of money is being siphoned off by investors. Of course, it's important to understand that a lot of different factors can influence the value of a stock, so it's best to consider the above as being indicative of a possible path for further study rather than definitive evidence.

There are numbers that don't seem to be as ambiguous, namely the disturbing reports about the difference in infection and death rates of private versus public and non-profit facilities. According to a May 6th press release by the Ontario Health Coalition, 

the rate of death, as measured by the proportion of deaths over the total number of beds in homes with COVID-19 outbreaks resulting in death, is:

• 9 per cent in for-profit homes
• 5.25 per cent in non-profit homes, and
• 3.62 per cent in publicly-owned (municipal) homes

Another relevant set of figures is the proportion of deaths per beds broken down by ownership model. 

From April 28 to May 5 the proportion of deaths over total number of beds in these homes increased or declined as follows:

• In for-profit homes the increase in the death rate has been 28.52 per cent.
• In non-profit homes the increase in the death rate has been 14.15 per cent.
• In public (municipal) homes the increase has been negative, thus, a decline of (-)18.46 per cent.

(In case readers are wondering about why the death rate would go down during a pandemic, I'm only speculating but social distancing has a side benefit of preventing the spread of other communicable diseases such as seasonal influenza, the common cold, and, Norwalk which commonly create localized disease epidemics in seniors centres. If people aren't getting the Corona virus, they probably aren't getting those things either---and they kill people too.)

The Canadian Armed Forces were asked by the premier to come to help in five Ontario Long Term Care Facilities (LTCF). They recently gave a report to both the Premier and the Prime Minister that briefly catalogues various deficiencies that they found. I won't go into the specific problems other than to cite some of the issues that "jumped out and bit me on the nose":

• lack of proper use of Personal Protective Equipment (PPE)
• use of medications past their expiry date
• general fear of management firing staff for using too many supplies and spending too much time on individual patients

What is of interest to this part of my post are the five LTCFs that the military report deals with:

• Eatonville Care Centre
• Hawthorne Place Care Centre
• Orchard Villa
• Altamont
• Holland Christian-Grace Manor

I've spent a lot of time trying to figure out who owns these different homes---and it is difficult to find out. 

The Eatonville Care Centre is in Etobicoke, but it isn't on the list of Toronto municipal LTCFs. There is nothing on the website that would identify it as being a privately owned business---either single proprietor, partnership, or, publicly traded incorporated company. But there isn't anything that would suggest that it is a non-profit charity, either. (I didn't see a "donations" link on the page---which would suggest that it isn't a charity---but "absence of evidence isn't evidence of absence".)

The Hawthorne Place Care Centre is on Finch Avenue, but again it isn't on the Toronto list.  Again, it doesn't list who owns what and there are no links for donations.

After a bit of searching, I found out that there are two "Orchard Villa"s in Pickering. One is a "retirement home", the other is a "long term care" facility, so I assume that the Armed Forces report is referring to the latter instead of the former. Moreover, after even more tedious searching, I found out that is part of a business called "Southbridge Care Homes". Like many large business websites, Southbridge Care Homes has an "investor relations" link to draw in potential investors. The URL comes up with an "Error 404" label, which Wikipedia says generally means that a specific page has been deleted, although it sometimes comes up for other reasons. Fortunately I was able to dig up a screenshot that the Internet Archives' "Wayback Machine" recorded on October 17th of 2018. According to it Southbridge Care Homes are owned by "The Yorkville Long Term Health Care Fund":

The Yorkville Long Term Health Care Fund is the investment vehicle that allows investors to invest in Southbridge Health Care LP. It is designed as a stable, yield based investment with opportunities for capital appreciation.

Through its investment in Southbridge Health Care LP, the Yorkville Long Term Health Care Fund’s stable yield is derived from a government funded long term care business that is growing as a result of positive demographic shifts and chronic shortages in health care beds. The Yorkville Long Term Health Care Fund provides investors access to an extremely successful management team and a business with significant barriers to entry.

It would appear that the "extremely successful management team" might be very good at making money, it didn't appear to have been very good at protecting the people entrusted to their company---at least at the Orchard Villa Long Term Care Facility.

The Altamont Care Community is in Scarborough and it's owned by Sienna. 

Holland Christian's Grace Manor has another one of those frustratingly vague websites. There's nothing on it to suggest that what sort of organization it is, other than a thick layering of "God speak".  (That doesn't mean something isn't a private business, though, as some businesses do this sort of thing.) Having said that, there was a guest on the CBC's The Current, who said that Holland Christian is a nonprofit. Moreover, the Toronto Star's "Daily Update" for May 27th at 2:30 pm had a story that said that of the five LTCF in the Armed Forces report, four were businesses and only one a non-profit---which clears up a bit of the mystery.    

Another mysterious thing about the Holland Christian website is the fact that if you bring up the home page it lists all the different facilities that they currently run or are building---except the one listed in the report: Grace Manor. But if you look at other pages, such as the one titled "Living at the Manors", you will see Grace Manor prominently displayed. Again, "absence of evidence isn't evidence of absence", but a casual observer might be excused for thinking that Holland Christian is trying to erase an embarrassment from the World Wide Web. 

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The fact that pages can be altered in order to remove embarrassing information from a website means that it's even more important to support journalism. I'd really suggest to you that if the people of Guelph won't support people who work hard to get the news out to you, you probably don't deserve to know what's going on in your community. What's holding you back? Only a dollar a month helps, and it's easy to do through Patreon and Pay Pal.

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Gordon goes on to talk about The Elliot as being an "oasis" in the midst of the current pandemic. He says that this is because it is a non-profit instead of a private corporation. I looked up the numbers at the Wellington-Dufferin-Guelph Public Health Unit and here are the relevant numbers current as of May 28. These include only resolved cases, as there don't appear to be any on-going cases in institutions as I write this post. 

• Guelph General Hospital, 22 cases---non-profit
• Guelph Lake Commons, 1 case---private, Hawthorn Senior Living
• Homewood, 4 cases---private, Homewood Health
• Norfolk Manor, 21 cases, 7 deaths---private, "family operated"
• St. Joseph's Health Centre, 1 case, 1 death---non-profit
• Stone Lodge, 1 case---private, owned by "Oxford Living", a large business that owns many properties in both Canada and the USA
• Village of Riverside Glen, 1 case---private company, "Schlegel Villages"

As you can see, being a non-profit doesn't immediately give an institution a "get out of jail free" card. But without drilling down into the specifics, I think it's important to realize that there is plenty of opportunity for comparing "apples to oranges" in the above list. Guelph General Hospital has a different mandate than a Long Term Care Facility, as does the Homewood, and, a dedicated seniors centre. But it is true that there doesn't seem to have been a single case in the Elliot---which might be evidence of "dumb luck" as much as showing that they do a better job protecting against infectious diseases.

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One last point about my conversation with James Gordon. Being a bit of an egomaniac instead of a good interviewer, I went on a bit of a rant instead of really listening to what my guest had to say. I originally asked James about why it is that governments always seem to wait until a horrendous scandal breaks instead of proactively dealing with a problem when someone brings it to their attention. His response was to talk a bit about being "nimble" and how government just inherently takes far too long to deal with any problem. But after that he transitions to talking about the "culture" of a specific issue. In the case of Long Term Care Facilities, he suggests that there is a "culture" that suggests that the private sector can do a better job than a public facility.

At this point our talk ceases to be a conversation and breaks into two monologues, mainly because of my failing as an interviewer. James is talking about the problem of public versus private ownership, whereas I was talking about how many scandals there are in our society if people were just willing to look for them. What links us together is a word that neither one of us uses: "ideology". 

The "culture" that Councillor Gordon is referring to is the ideological assumption that the private sector is always more efficient than the public. And it is true, that depending on how you define "efficient" it can be said to be so. For example, the private sector seems to be much better at forcing people with limited power to work for less money under nastier conditions. It also seems to be able to take care of patients at a facility for less money---but at the price of lowering the ability of the home to protect people from infectious diseases. But having said that, as I have pointed out in the bullet points above, there are non-profits in Guelph that have had outbreaks too. 

The reason why we went on our different tangents is because I think that James was indulging in a little ideological thinking too. He thinks that the dividing line is whether or not Long Term Care Facilities should be publicly or privately owned. In contrast, I think that the real issue is that governments---of all stripes---have a real problem responding to problems before they blow up in their faces. That's not an ideological issue, instead it's a systems question. Why is it that governments aren't---to use Gordon's term---"nimble" or to use mine "proactive"? We'll get more into that issue in the next part of our conversation.

Councillor Gordon looking towards a brighter,
publicly-owned future!  Image provided by him.

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Moreover, I say unto you the Climate Emergency must be dealt with!