Abuse can thrive in understaffed PCHs, especially for-profit ones, expert says in wake of Winnipeg allegations

A seniors' advocate is calling for a privately-owned personal care home's licence to be suspended and for the government to take over administration of the Winnipeg facility in the wake of allegations of abuse impacting 15 residents.

The Winnipeg Regional Health Authority said at a news conference Tuesday that it's investigating allegations of abuse by two care aides at Oakview Place, which is owned by Extendicare. The province and police are also investigating.

Eddie Calisto-Tavares says she feels heartbroken for the residents and families of the Sturgeon Heights personal care home, but also anger for the lack of accountability that allows wrongdoing to fester.

"For the apathy and the lack of action from both our government elected officials and the Winnipeg health region that continues to make excuses and allow for these for-profit homes to function," she said in an interview with CBC News on Thursday.

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Calisto-Tavares's father, 88-year-old Manuel Calisto, was a resident of Maples Long Term Care, another privately-owned for-profit facility.

At Maples, 56 residents died from COVID-19 during an outbreak declared in October 2020. By the time it ended after nearly three months, 157 residents and 74 staff had been infected, according to a report commissioned by Manitoba Health.

Calisto-Tavares's father was among those who died in what she calls "Nightmare at Maples," when eight people died in a 48-hour period, resulting in a rapid response team being deployed.

A lack of staff is an ongoing problem in for-profit homes across the world.

Understaffed homes

For the last 15 years, Pat Armstrong has studied long-term care internationally and wrote a book on the privatization of personal care homes in 2020.

Throughout her studies, the distinguished research professor emeritus at York University says she's found that abuse thrives in personal care homes that are understaffed, and consistently the most understaffed facilities are privately-owned.

"If you're in that place to make money, your focus is on paying the least amount of money for care that you can in order to make a profit," Armstrong said.

"We have clear patterns of fewer staff around, and those staff that are there are paid less. They have less time to do things like support each other, less time to talk someone down or be talked down themselves."

Eventually, Armstrong thinks for-profit personal care homes will be phased out, but in the interim, governments should be proactive in terms of regular inspections rather than reactive when it comes to serious breaches of care.

She says interventions after abusive or neglectful situations in Canada and elsewhere have largely been ineffective because they were more about regulation rather than change.

"The regulations were primarily about the staff rather than about the managers and the owners of the place. And it hasn't necessarily fixed what's going on," Armstrong said. 

CBC News asked the ministers of health and long-term care for comment on Thursday afternoon, and responses were not received.

Déjà vu

On Tuesday, the WRHA held a news conference alongside a representative from Extendicare to announce the abuse allegations and the steps taken to address the problem.

A whistleblower informed Oakview Place' management of the abuse in February, but management never informed police or the WRHA about the allegations, and it took another whistleblower to inform the health region four months later.

After the WRHA stepped in, two care aides were placed on paid leave and the police became involved.

It's not known what kind of abuse is being alleged.

The news conference brought Calisto-Tavares back to the day where the health authority announced the weekend crisis at the Maples together with a representative from the company that owned the home, Revera. 

The WRHA later said that spokesperson had given "less than accurate" information about the level of staffing that night in November and, in fact, only seven of 19 scheduled health-care aides were present at the Maples home from 7:30 p.m. to 11:30 p.m.

Calisto-Tavares takes issue with for-profit long term care facilities because she believes they compromise on care and the government gives them free rein until something bad happens.

"The government does not monitor and does not have a standard of care that says, 'Here's where the money is going. This is the training that you need. This should be the amount of full-time staff you should have. This is how you do ongoing training and monitoring,'" she said.

In the case of Oakview Place, Calisto-Tavares says the province should have immediately taken over operation of the facility and put its licence under suspension.

Manitoba Health Minister Audrey Gordon and Seniors and Long-Term Care Minister Scott Johnston said as there is an active criminal investigation ongoing they are limited in what they can say, though they felt "appalled by the allegations."

"From the moment these terrible allegations were reported to Winnipeg Regional Health Authority, the WRHA has been intricate in ensuring that the appropriate actions were taken according to processes that were already in place to protect seniors in our province including conducting unannounced visits and speaking with staff and residents," read their statement from last Thursday.

"Our government is committed to full co-operation with all investigations related to this matter and will take action on any recommendations arising from these investigations to protect seniors in care."

Extendicare didn't respond to questions from CBC News, but pointed to a previously-released statement from the newly appointed Manitoba regional director and director of operational quality for Western Canada in which she apologized for the facility's handling of the allegations.

As of March, Extendicare assumed operational management of seven Revera-owned personal care homes in Manitoba.

Beds needed for seniors

Private care homes are a way to ensure there are enough spaces for older adults who need extra care when public care homes are full, especially as Manitobans are rapidly aging, said Laura Tamblyn Watts, the CEO of CanAge.

However, there are some concerns about how some private facilities earn profits, she said.

"The concerns are always, where is that profit coming from? Is it coming from shortages of staffing? Is it coming from cutting corners," Tamblyn Watts said in a Thursday interview.

"Are Manitobans getting their value for the money and are standards being lived up to? And that's, I think, one of the reasons why we do need national standards for long-term care."

Tamblyn Watts says the province plays an important role in ensuring there are beds for seniors and that they are appropriately cared for, but government isn't doing enough to protect residents in care homes.

More needs to be done to improve training on abuse response and prevention, and legislation must be introduced to curb it, she said.

Calisto-Tavares says family plays an important role in advocating for residents, especially in cases like the outbreak at Maples Long Term Care and the latest allegations of abuse.

"We matter, and we are the only ones that can make these changes long-term," she said.

"Don't stop using your voice. Be brave. It's okay to go public with your name. There is no shame on you. There's shame on them. There's shame in our government."