Canada’s public health care system is widely celebrated, and with good reason. Following years of struggle, the problems posed by private health care provision were overcome with the establishment of a universal and public single-payer medicare system in the 1960s. Bernie Sanders and others involved in the inspiring Medicare For All campaign in the United States often point to Canada’s single-payer system as a model to be followed.
However, the experience of the COVID-19 pandemic has reminded us that, for all its strengths, Canada’s health care system still has very real limits. It excludes from its formal scope crucial elements such as pharmacare, dental care, mental health — and also something that has been vital over the past year: long-term care (LTC). The result is a confusing mixture of public, not-for-profit, and for-profit ownership, and delivery in all of these areas. This has led to the growth of for-profit provision throughout the neoliberal period.
The pandemic has revealed just how serious, and even deadly, those exclusions have been. In particular, the catastrophic performance of Canada’s for-profit LTC providers is now widely recognized. The details of one particularly tragic COVID-19 outbreak at a Canadian LTC home in November reveal the human suffering inflicted by profit-hungry LTCs. One of Canada’s largest pension funds owns the LTC in question, raising grave questions about the investment strategies it follows.
The Maples Care Home Disaster
On the evening of Friday, November 6, a group of paramedics were called to a long-term care facility called Maples Personal Care Home, in Winnipeg, Manitoba, where they discovered the dead bodies of two residents. They found several other residents to be dehydrated, hungry, and in urgent need of care. The next morning, one of the paramedics anonymously posted a message to Reddit describing what they had seen as “something out of a nightmare”:
While assessing patients the medics were asked to check on another resident that was described as “not breathing.” When the medics went to check they noted that this resident was dead for hours. Rigidity and lividity had already set in. The paramedics on scene expressed this and moved back to checking on the other residents … Medics reported that some of these residents were just hungry but didn’t have the ability to feed themselves. Medics spoon fed these residents. Some were dehydrated and the paramedics on scene established IV access and gave fluids and it helped the residents. While this was going on the nurse reported another cardiac arrest. The paramedics went to assess the cardiac arrest and noted … that this resident had been dead for hours with rigor set in.
An outbreak of COVID-19 was ripping through Maples Personal Care, owned by Revera Inc., Canada’s second-largest owner of for-profit LTCs. According to the Reddit post, Maples workers told paramedics that they were “understaffed.” Within forty-eight hours of the emergency call being placed, eight Maples residents died. To date, an estimated fifty-six Maples residents have died.
At a tense press conference the next day, Revera Regional VP Jason Chester surprised those in attendance when he claimed that staffing at Maples on the previous night had been “at its full complement.” The next day, the media reported that two unions representing Maples workers had made statements contradicting the company’s assertions.
Another day later, as the evidence of Revera’s staffing failure mounted, management finally admitted that their claim of “full complement” staffing had been untrue. The facility had actually been left for a significant period with only seven of nineteen health care aides, and less than a full crew of seven nurses.
The company issued a weak apology, claiming that the false information given was simply a “miscalculation.” Revera’s admission prompted widespread condemnation. Wab Kinew, the leader of Manitoba’s official parliamentary opposition, the New Democratic Party (NDP), declared that the people of Manitoba “had been lied to” by Revera.
Understaffing for Profit
There is now substantial evidence that the understaffing of the Maples home on November 6 was far from exceptional. Family members as well as frontline staff unions have argued repeatedly that Revera regularly understaffs their facilities. This appears to be standard procedure, revealing a cold but rational calculus — every unpaid shift reduces operating costs and boosts the company’s profitability.
In August 2020, a research paper revealed that death rates in for-profit LTC homes were over four times higher during the pandemic’s first wave than in publicly owned institutions. A more recent investigation by Canada’s public broadcaster (CBC) reported that death rates in homes owned by the larger, corporate chains — including Revera — were even higher.
These findings are consistent with longer-term and international research carried out by York University’s Pat Armstrong and a team of investigators, which concluded that “homes run on a for-profit basis tend to have lower staffing levels.”
According to Armstrong and her colleagues, for-profit LTCs follow managerial practices that involve “paying the lowest wages possible, and hiring part-time, casual and those defined as self-employed in order to avoid paying benefits or providing other protections.” It is precisely these exploitative, profit-maximizing practices that prove to be so dangerous for both workers and residents during the pandemic.
Revera’s Pension Fund Ownership
While the Maples home crisis has parallels elsewhere, there is one peculiar aspect of Revera that has great political importance: it is the wholly owned subsidiary of a parent company known as PSP Investments (PSP). PSP is an investment company, established by legislation in 1999 as a crown corporation and owned by the Government of Canada. It has a mandate to manage the funds of four federal government pension plans, replacing the previous “pay as you go” system that required no such investments.
This means that the Revera chain of LTC homes, including the Maples home in Winnipeg, are held by a publicly owned — but profit-generating — pension fund manager set up to capture financial market returns to help pay for pensions. Returns on investment are supposed to reduce the shared contributions necessary to make pension payments, benefitting both the federal government and the workers who belong to its pension plans. Since PSP was established, the government has increased member contribution rates and cut benefits.
To achieve this lofty goal, PSP received a statutory obligation to invest like any good capitalist entity — in ruthless pursuit of “a maximum rate of return.” PSP’s 100 percent ownership of Revera is a “private equity” structure, which means, among other things, that it is under no obligation to disclose its profits to anyone — not to plan members, not even to its ultimate government owners.
This makes PSP a neoliberal innovation. It is a new kind of “public-private partnership” — a so-called P3 — in which a state owner harnesses the profit drive of financial capital, without any democratic control or accountability.
Revera’s ownership by a pension fund was virtually unknown before the pandemic. However, with the sudden surge in COVID-19 deaths that was especially concentrated in for-profit LTC chains, PSP’s role suddenly gained media attention.
This public scrutiny sparked debate about the role of public service unions. But neither the members of the “client” pension plans nor any of their unions have any authority over PSP. In fact, legislation prevents these unions from even raising pension benefit issues, never mind controversial investment matters. PSP is owned and governed by the federal government alone.
Making Revera Public
Nonetheless, when death rates in for-profit LTC facilities began to surge in April, including hundreds of deaths in Revera-owned homes, one union had had enough. On May 26, the Public Service Alliance of Canada (PSAC) — the largest of the eighteen unions representing workers in the federal public service — took the exceptional step of publicly calling on PSP to put Revera “under public ownership and control.”
This call was unprecedented. The union was not proposing a mere “divestment” of Revera — it was not calling for Revera to simply be sold off to some other for-profit investor. It was acting on its principled view that health care — including long-term care — should be publicly owned and operated.
PSAC did not fall back on the recently popularized “principles of responsible investment” with an appeal for more “ethical” profit-making by Revera. As a union, PSAC knows that Revera’s profits are generated through an especially brutal exploitation of its workers — mostly women and disproportionately racialized — and the minimization of resident care and support. Their response was a much bolder call for Revera to be socialized by transferring it into public ownership.
This has sparked a lively movement, closely aligned with the many researchers and advocates that have spent years fighting for a better, public LTC system. In September, the Ottawa Health Coalition organized a virtual Town Hall meeting called “Make Revera Public.” Attendees tuned in from across Canada. An online letter campaign was launched, attracting over three thousand signatures.
In the following weeks, activity ramped up. On October 7, the second-largest public service union joined the PSAC call, arguing that “our pensions should not be making profits from long-term care homes.” After the awful November events at the Maples home, political leaders from the center-left New Democratic Party added their support. The Manitoba Health Coalition organized another “Make Revera Public” town hall meeting on December 2. Mainstream media began reporting on the campaign, and on December 24, a third major public service union also joined the call.
Public LTC has broad popular support. One poll found 86 percent support for a transformation of the system that would end the role of for-profit operators. Prime Minister Trudeau suggested in May that “everything is on the table” to improve long-term care for seniors. The campaign will move into 2021 with real momentum.
The exclusion of long-term care from Canada’s health care system was a costly mistake. It allowed neoliberals to pursue public expenditure cuts and the expansion of for-profit LTCs alongside other private health services.
The Canadian response should take inspiration from the vigorous Medicare For All movement in the United States. It must intensify the struggle for a universal public system that includes LTCs and other components that are currently left out. But that system can only work if it values and properly compensates the highly gendered and racialized workforce that carries out so much of its vital care work.
The Revera story shows that our dependence on capitalist financial markets for pension benefits and other funding needs is a serious problem. Private-public partnerships do not innocently lay golden eggs: they integrate the provision of social services into a predatory system that will inevitably produce more and worse Reveras. We urgently need a struggle to decommodify essential goods and services, and ultimately to put finance itself under democratic control.