04 Jan Expand and Extend

B

ut I must explain to you how all this mistaken idea of denouncing pleasure and praising pain was born and I will give you a complete account of the system, and expound the actual teachings of the great explorer of the truth, the master-builder of human happiness. No one rejects, dislikes, or avoids pleasure itself, because it is pleasure, but because those who do not know how to pursue pleasure rationally encounter consequences that are extremely painful. Nor again is there anyone who loves or pursues or desires to obtain pain of itself, because it is pain, but because occasionally circumstances occur in which toil and pain can

No one rejects, dislikes, or avoids pleasure itself, because it is pleasure, but because those who do…

procure him some great pleasure. To take a trivial example, which of us ever undertakes laborious physical exercise, except to obtain some advantage from it? But who has any right to find fault with a man who chooses to enjoy a pleasure that has no annoying consequences, or one who avoids a pain that produces no resultant pleasure?”

“But I must explain to you how all this mistaken idea of denouncing pleasure and praising pain was born and I will give you a complete account of the system, and expound the actual teachings of the great explorer of the truth, the master-builder of human happiness. No one rejects, dislikes, or avoids pleasure itself, because it is pleasure, but because those who do not know how to pursue pleasure rationally encounter consequences that are extremely painful. Nor again is there anyone who loves or pursues or desires to obtain pain of itself, because it is pain, but because occasionally circumstances occur in which toil and pain can procure him some great pleasure. To take a trivial example, which of us ever undertakes laborious physical exercise, except to obtain some advantage from it? But who has any right to find fault with a man who chooses to enjoy a pleasure that has no annoying consequences, or one who avoids a pain that produces no resultant pleasure?”

In Alberta this week, there has been heated debate over the province’s alleged plan to attract more private investment to the long-term-care sector by raising the ceiling on fees they could charge.

Alberta has also seen a six-per-cent increase in for-profit beds and a double-digit decrease in non-profit residential beds between 2000 and 2007. The general argument in favour of this approach is that it does not matter who delivers the services as long as they are publicly funded.

However, the published research demonstrates that contracting out care to private, for-profit facilities is likely to result in inferior quality of care compared to care delivered in public and non-profit facilities.

research demonstrates that contracting out care to private, for-profit facilities is likely to result in inferior quality of care…

For example, one key measure of quality in residential care facilities is nurse staffing levels. Studies have consistently found that for-profit facilities have lower nurse staffing levels and higher turnover rates compared to non-profit and public facilities. Other indicators of poor care quality, such as rates of pressure ulcers or bed sores, are also found to be higher among residents in for-profit facilities. Canadian research from Manitoba and British Columbia has found that residents of for-profit facilities have higher rates of hospitalizations for care-sensitive conditions such as pneumonia and dehydration.

The evidence also suggests that the greater the profit, the worse the outcomes. In one study, for example, for-profit facilities with the highest profit margin had significantly more regulatory inspection deficiencies than those in the next-lowest profit group. So what is behind this relation between profit and inferior care? One explanation is that there is a trade-off between the additional costs of improving quality (for example by hiring more staff) and revenue generation. Where the pressure to make a profit is strong, quality may be sacrificed. Another explanation may be related to the greater ability of non-profit organizations to mobilize volunteers who provide companionship to residents and raise funds for capital equipment.

While the link between for-profit facility ownership and poorer care does not imply that all for-profit facilities provide poor care, the evidence suggests that, as a group, such facilities are less likely to perform as well as non-profit or public facilities.