Extendicare axes 4-person rooms, but plans to replace decades-old Sask. nursing homes remain in limbo

Nicole Baker is only 51, but she's been thinking lately about where she'll live as she gets older and perhaps requires nursing care.

She "100 per cent" does not want to live in a home owned by the company Extendicare, she says — not after her family's experiences.

Baker remembers visiting her father in Extendicare's home in Moose Jaw, Sask., in 2015 and seeing people in wheelchairs lining the hallways, stretching out their hands. 

"Like a horror film to me. Dystopian, almost," she said. 

Last September, Baker's 71-year-old brother, Brian Pitchford, moved to Extendicare's Parkside home in Regina, after coming off chemotherapy and radiation treatments for colon and lung cancer. She spoke to him daily before he died last month, she says.

Brian "hated" sharing a room with three other residents, and despite his room being near the nurse's desk, calls for help went unheeded, she said. 

"'You can press it,'" Baker recalls Brian saying of his call button. "'They don't come.'" 

5 homes, 5 outbreaks

Concerns about crowded rooms and staffing shortages have dogged Saskatchewan's long-term care system for years. 

But the COVID-19 pandemic has magnified those worries, especially given Extendicare's experience in recent months.

The publicly traded, Ontario-based company has a contract with the Saskatchewan Health Authority to operate five long-term care homes in the province: the facility in Moose Jaw, Preston in Saskatoon, and Parkside, Elmview and Sunset in Regina.

While other nursing homes are in similar pacts with the province, Extendicare is the only owner that's private and for-profit. 

It's also stood out among homes during the COVID-19 pandemic. 

An outbreak at Parkside from late November to early January was linked to 41 resident deaths. It raised questions about the company's infection control measures and crowded rooms, and sparked an ombudsperson investigation and a class-action lawsuit. 

Extendicare's four other homes in Saskatchewan have also experienced COVID-19 outbreaks. An outbreak at the Regina Sunset home was declared Tuesday, after one resident and one worker became infected. 

All of which raises a host of questions. Will the company stop housing residents four to a room? Will staffing levels increase? And will the homes themselves — some of which date back to the early 1960s — be replaced? 

Essentially, will the COVID-19 pandemic spur any major changes at the company that experienced the deadliest nursing home outbreak by far in Saskatchewan?

Here's what the company said. 

2-person rooms now the norm 

Before the outbreak, the majority of rooms at Parkside housed four residents, according to the company's latest annual information form.

"The age and structure of a care home — ward-style rooms initially with up to four residents living in close quarters — are strongly correlated with worse spread of COVID-19," Extendicare's spokesperson said.

Extendicare began limiting room occupancy in its homes across Canada to two residents in early December "as community spread of COVID-19 continued to increase in [Saskatchewan]."

Nicole Baker said her brother was moved to a room at Parkside with just one other person in mid-December. 

The Parkside outbreak was declared over in January, opening the way for new admissions, though new residents must be vaccinated against COVID-19, the Extendicare spokesperson said. 

The new resident-to-room ratio will remain in place "on an ongoing basis," she added.

Matt Love, the Saskatchewan NDP's critic for issues affecting seniors, applauded the change. However, he said it points to the need for something the party has demanded for years: fully funded, legislatively guaranteed minimum standards of care in long-term care homes.

"We need to have enforceable standards that aren't just left up to the interpretation of individual homes or operators," Love said.

Staffing levels depend on province: Extendicare

Baker says Brian had good things to say about Parkside staff, particularly one favourite nurse who left the facility at some point during the outbreak.

He just wished there was more staff to go around, she said.

The combined total bed capacity at its long-term care homes in Saskatchewan has remained at 649 for several years, according to the company's annual information forms. Extendicare employs more than 650 full- and part-time staff across those homes but says it would like to have more.

"Seniors' care, and the support it receives, must modernize to meet the needs of residents," the Extendicare spokesperson said. "This includes increased staffing levels."

Those staffing levels depend on the amount of funding Extendicare receives as part of its agreement with the Saskatchewan Health Authority, the spokesperson said.

Higher staff-to-resident ratios would require a boost in provincial funding, she said. 

$40M in provincial funding last year

Extendicare is what's called a designated health care organization, and so receives funding from the Saskatchewan government to help it run its five long-term care homes under a funding agreement with the Saskatchewan Health Authority.

Beginning in 1984, "commercial homes (for-profit) were funded on a negotiated fee-for-service basis," said a spokesperson on behalf of both the SHA and the Ministry of Health. 

Over the last decade, provincial funding to Extendicare has gone from $32 million in 2011 to $40.1 million last year, according to annual filings by SHA and its former regional health authorities:

Today, the company is asking for a "sustainable" level of funding from the Saskatchewan government. In addition to increasing its staff levels, Exendicare said it wants to replace all five of its Saskatchewan long-term care homes with facilities built to modern standards.

"The current funding model does not make this possible," the Extendicare spokesperson said. 

Nor does the current funding — when measured against the cost of unionized staff and suppliers — lead to profits locally, according to the company. 

"We do not make any profits from delivery of care in Saskatchewan," the spokesperson said. 

Read a statement from Extendicare about its Saskatchewan operations below. Don't see it? Click here.

Baker and the NDP's Love are skeptical of Extendicare's asserted break-even status. 

"I'm not buying it," Baker said. 

"It's hard to imagine," Love said. "They're not operating out of the goodness of their hearts. They're a corporation that's required to generate profits for their shareholders."

COVID-19 led Extendicare to increase its spending in Saskatchewan, "without regard to funding," by an extra $3.6 million in 2020, of which $2.2 million has been reimbursed by the provincial government, the spokesperson said. 

"We will continue to make these investments until the pandemic subsides."

Extendicare is a big company, with 57 long-term care homes across Canada. According to its 2019 annual report, it had net earnings of $28.6 million.

In the fourth quarter of 2018, the company wrote down the value of three Saskatchewan retirement homes but those were specialized retirement homes operated under an "Esprit" subsidiary banner. They fall outside Extendicare's funding agreement for Saskatchewan long-term care homes. 

If those homes are unprofitable as Extendicare maintains, "I would say that they probably wouldn't mind leaving the province and then having their operations taken over," Love said.

"We think the government should do that right away to protect the residents, because we've seen the outcome's clearly better in SHA owned and operated homes."

Replacement plans date back years 

Extendicare is instead hoping the province will chip in to help the company replace all five of its Saskatchewan long-term care homes, at an estimated cost of $72 million for one 256-bed home. 

"Older long-term care homes present a significant challenge for delivery of care," the Extendicare spokesperson said. "It is an issue that the COVID-19 pandemic has made abundantly clear in the outbreak outcomes of these homes compared to newer buildings."

The newest of Extendicare's Saskatchewan long-term care homes — Sunset in Regina — was built in 1971. The other four date from 1963 to 1965.

For comparison, Saskatoon's downtown library, which opened in 1966, is being replaced with a building budgeted to a maximum of $134 million.

Extendicare said it has proposed replacing its homes for years.

In 2014, the Saskatchewan government budgeted $1.5 million partly to fund "planning associated with the Regina Extendicare replacement." 

Five years later, the Saskatchewan Health Authority's 2019 inspection report for Parkside — which stated the home "does not meet current standards of care" — also indicated that Extendicare had proposed replacing the building and was awaiting a response from the SHA and the Ministry of Health.

The Extendicare spokesperson says the company "continued during the pandemic to firmly advocate for needed measures to protect long-term care residents in the province, including the need for reduced room capacity to a maximum of two residents."

Provincial approval needed, company says

Extendicare's designs for new buildings include single rooms with some shared bathrooms and "significantly more space" for dining, recreation, storage and hallways. 

But the company needs the Saskatchewan government's approval to build new homes, according to the Extendicare spokesperson. 

"There has been no program put in place to enable this to happen," she said. 

Asked why the province hasn't approved Extendicare's plans, the spokesperson for the health authority and the Ministry of Health replied, "[We] are currently exploring options to address long-term care capital needs in Regina and across the province.

"Discussions with long-term care homes are ongoing."

Love says the time for talk is over.

"There's a long history of reports and investigations," he said. "[Extendicare and the government of Saskatchewan] successfully managed to pass the buck off to one another and it's resulted in zero improvements being made to long-term care." 

Both Love and Baker said the frequency of long-term care home inspections needs to increase, too. Baker pointed to a scabies outbreak that happened at Parkside after the COVID-19 outbreak, even as the Saskatchewan Health Authority acted as temporary co-manager of the facility.

"It speaks to the level of cleanliness," Baker said.

"The province was still working in conjunction with the care home. How does this even happen?"