1. A Major Collaborative Research Initiative funded by the Social Sciences and Humanities Research Council of Canada OWNERSHIP MATTERS Pat Armstrong, PhD, Principal Investigator, York University Presentation at Toronto City Council’s Community Development & Recreation Committee January 11, 2012

2. Complaints Compared with for-profit chain facilities, non-profit, charitable and public facilities had significantly lower rates of complaints in Ontario. Likewise, in British Columbia’s Fraser Health region, non-profit facilities had significantly lower rates of complaints compared with for-profit facilities.

3. Staffing The top 10 for-profit U.S. chains had lower RN and total nurse staffing hours than government facilities, controlling for other factors. Other for-profit facilities also had lower staffing. Canadian data show for-profits have significantly lower levels of direct care staff than non-profit and government facilities.

5. Quality A Manitoba study found for profits had higher: Rates of falls Pressure ulcers Respiratory infections Fluid and electrolyte imbalances Excessive medications

7. Violations of Regulations The top 10 chains received 36 percent higher deficiencies (violations of regulations) and 41 percent higher serious deficiencies than government facilities. Other for-profits had higher deficiencies than government facilities. These deficiencies increased after purchase.

8. Sustainability Southern Cross, the largest for-profit provider in the UK, collapsed in 2011 House of Commons Public Accounts Committee Report of December 2011 raises concerns about the trend towards fewer, larger providers of residential and home care. Government had little warning, residents had no options

9. Sources Doupe M. et al. (2006) Using Administrative Data to Develop Indicators of Quality Care in Personal Care Homes. Winnipeg, MB: Manitoba Centre for Health Policy. Harrington, C. et al. (2011) Nurse Staffing and Deficiencies in the Largest For-Profit Chains and Chains Owned by Private Equity Companies. Health Services Research, August DOI: 10.1111/j.1475-6773.2011.01311.x

10. Sources Continued Harrington, C. et al. (2011) Ownership, Financing, and Management Strategies of the Ten Largest For-Profit Nursing Home Chains in the United States. International Journal of Health Services, 41(4): 725–746. McGregor, M.J. et al. (2011) Complaints in for- profit, non-profit and public nursing homes in two Canadian provinces. Open Medicine, 5(5):e183–e192.

11. Sources Continued McGregor, M.J. et al (2011) A Survey of Nursing Home Organizational Characteristics Associated with Potentially Avoidable Hospital Transfers and Care Quality in One Large British Columbia Health Region. Canadian Journal on Aging, 30(4):551-561. McGregor, M.J. et al. (2010) Trends in long-term care staffing by facility ownership in British Columbia, 1996 to 2006 Health Reports 21(4):1-8.