Opinion: Quebec should drop idea of nationalizing private care homes

More government is rarely the answer. Legault should use the tools he already has to bring about significant improvements.

Published by the Montreal Gazette as an op-ed piece on 2020-5-20:

Premier François Legault has suggested that private nursing homes could be “nationalized” in response to problems brought to light by incredible COVID-19 infection and death rates among residents of these homes. More government: a typical Quebec response to a problem.
Consider how this approach might play out for other serious health or safety problems. Mines are dangerous workplaces. Should the government be running mines? Medications can be dangerous if improperly manufactured or distributed, or prescribed for the wrong indications or in incorrect dosages. Do we want governments to take over development, manufacture and distribution?
More government is rarely the best answer. Bureaucrats get paid according to the size of the department and the budget they manage. They are incentivized to spend more taxpayers’ money, not less! Equally problematic is the lack of competition when governments take over a service or industry. Competition is what drives efficiency and lowers prices for consumers.
Governments can bring about significant safety improvements, however: workers’ compensation laws that cost employers dearly for accidents that they are even partially responsible for; regulatory agencies that set standards, carry out inspections and impose fines or take away operating permits for infractions; and for professions — including pharmacists, nurses, physicians, or engineers — requiring the establishment of professional orders mandated to protect the public.
Let’s consider safety in nursing homes, where PABs (Préposés aux bénéficiaires) provide the bulk of direct patient care. PABs are poorly paid and are often immigrants, desperate for money and therefore willing to take jobs that other people turn down. To increase profits, their employers may refuse to provide full-time jobs or continuous employment to get out of paying time-and-a-half for overtime, or three weeks vacation after three years, or paid public holidays. As we’ve witnessed during this pandemic, part-time workers may have little choice but to work in more than one establishment, thus carrying the virus from one nursing home to another. PABs may not be provided with sufficient personal protective equipment, such as face shields, masks, and gloves; the supplies they have may be outdated or of poor quality, and workers often receive inadequate training in their use.
Before nationalizing the private nursing home industry, we need to ask:
In Quebec, why don’t we have a regulatory agency specifically for this industry? Are there adequate standards? Surprise inspections? Public posting of infractions? Fines big enough to change behaviour?
Should there be a professional order for PABs, which could regulate training, licensing, and continuing education? What about a professional order for nursing home managers, a highly specialized occupation dealing with a particularly vulnerable clientele?
We also need to ask, is the Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST), which is responsible for applying occupational health and safety laws, doing everything it should? CNESST inspectors can look into health and safety measures at workplaces; when problems are found, available remedies include closing down work premises and levying fines. Unfortunately, the CNESST is unlikely to act unless workers complain, while workers unaware of recourses available to them because of language or literacy issues, or lacking access to online information, or in fear of reprisals, are unlikely to make complaints. Many PABs infected on the job may fit that description.
We can hope that citizen advocacy groups, CLSCs, community organizations and, yes, CNESST employees, reach out to these individuals to help make them aware of their rights, support them in filing complaints and in following up. I have no doubt that substantial fines and increases in CNESST premiums would encourage private nursing home operators to remedy at least some of the problems exposed by the pandemic.
Legault should use the tools he already has. Don’t burden us taxpayers further by nationalizing private nursing homes!

Henry Olders is a retired geriatric psychiatrist.

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