The fallacy of efficiency

Written by Brenda Schimke

How is it more cost-effective to subsidize private businesses than directly support our seniors in long-term care facilities?  

Who truly benefits when a profit-seeking middle man sits between government tax dollars and senior’s care?

A growing body of evidence clearly shows that the type of ownership matters in senior’s care. 

Dr. Margaret McGregor, clinical associate professor at UBC and Dr. Pat Armstrong, distinguished research professor at York University, were recent guests on a webinar sponsored by the Friends of Medicare and Public Interest Alberta.

What they reported was not surprising or new to me. My mother and I had lived that reality for 10 years. After losing her husband, my father, and going blind in one eye, she asked if it was all right for her to move close to us. We were delighted and she chose a for-profit Rivera facility blocks from our home.

Money was not the issue, neither at that time, care. The in-house meals were splendid, the entertainment, daily exercises, community tours, church services and social activities were very good. Even the fact that my mother was able to walk two blocks to a shopping centre gave her freedom and independence.

Then, it was not. 

When extensive care became necessary, my mother’s care was increasingly inhumane. I regularly begged Home Care to move her, they regretfully advised that until she broke some bones, she would never get moved.

And that’s just what happened. A broken shoulder, hip reconstruction and 100 days between three acute care hospitals was what it took for her to escape. 

Thankfully her last nine months of life was in Coronation’s long-term care facility, publicly-owned and operated, where she received excellent and compassionate care.

Senior care needs range from independent to fragile. The higher the staff levels and the lower the staff turnover, the better the care for those who are completely dependent on others. 

Regular and familiar caregivers provide ‘relational care’, they know what will and will not please their patients, resulting in more positive outcomes and lower mortality rates. 

Even more important, they have some time to just chit chat with our loved ones.

COVID-19 showed everyone just how poorly provinces have managed long-term care and the absolute need for national standards under the Canada Health Care Act. COVID deaths and inhumane care are higher and more tragic in for-profit care facilities.

It also exposed the lie of ‘efficiency’ preached by private sector providers, when in fact, efficiency is simply cutting staff and lowering standards of care. A large body of literature shows for-profit facilities have the lowest ratio of caregiver to patient and are staffed by low-paid, temporary workers.

Efficient is simply code for siphoning as much taxpayer dollars as possible into shareholder returns. 

Again, the question becomes, how does a middle man actually enhance the care of our most fragile seniors? 

Of course, the answer is, it doesn’t.

My mom’s time at a for-profit facility, while she was able to take care of herself, was splendid—I have nothing but praise. But the fact that it became an inhumane prison with inadequate care once she couldn’t take care of herself highlights where private and public delivery of senior’s care should start and end.

My dad, unlike my mom, could make his own choice. When the decision was to either have an open- heart surgery and because of his previous stroke, live out his remaining life in a nursing home, he chose death. 

My dad was the lucky one, whereas my mom was the victim of profit-takers and the ‘fallacy of efficiency’ when caring for fragile seniors.


Brenda Schimke

ECA Review

About the author

Brenda Schimke

Schimke is a Graduate with Distinction from the University of Alberta with a BCom degree. She has lived and worked in Alberta, BC and Ontario.