Chapter Five: Contracting-Out Care: Nursing Homes in Canada

Long-Term Care Facility Workers’ Perceptions of the Impact of Subcontracting on their Conditions of Work and the Quality of Care: A Qualitative Study in British Columbia, Canada

“…They are not atypical either. Our findings are commensurate with other research that has documented significant negative consequences for workers (Armstrong & Armstrong, 2020a; Stinson et al, 2005; Vrangbæk et al, 2015)…”

“…Research on contracting out in the LTCF sector has also shown that the profits made tend to be taken from workers, through a number of tactics that keep labour costs down (Armstrong & Armstrong, 2020a; Stinson et al, 2005). Our findings add to this body of evidence.…”

“…Whereas Vrangbæk et al (2015) examined contracting out across the public sector, research focusing on the health care sector has also found deteriorating working conditions and negative changes to workforce composition (Armstrong & Armstrong, 2020a). In a study of the contracting out of health support workers, Stinson, Pollak, and Cohen (2005, p. 2) reported that newly privatized jobs were “substandard in all respects: low pay, meagre benefits, heavy workloads, poor training, and no job security.” They also found that the combination of heavy workload, insecurity, inadequate compensation, and emotional stress not only had negative repercussions for workers but also significantly harmed their family life as well as their engagement within the community.…”

Is there a future for nursing homes in Canada?

“…Research on for-profit tends to focus on facility ownership without also looking at the services contracted out to for-profit owners, services such as food, laundry, housekeeping, security, and even management. As our research has shown, 15,16 these services are critical to quality care. When they are contracted out, they undermine the teamwork that is so essential to care while too often failing to provide quality services.…”

“…In addition, moving forward means creating effective ways for all who live in, work in, and visit in long-term care to participate in decision-making and in designing more appropriate physical spaces, strategies that need not mean more money. 15,16 Ontario regulations require each home to have a residents’ council but too often they primarily serve as ways for managers to deliver messages. The same too often also holds for family councils, which regulations allow but do not require.…”