How Do Nursing Homes in the U.S. Compare to Those in Canada?
Not so well according a surveyor of both
A letter to the editor in The Boston Globe decrying the state of nursing homes in Massachusetts as compared to those in Canada caught my attention. So I invited its author, James A. Lomastro to be a guest on my podcast to describe the differences and explain why they exist.
Better Care in Canada
Lomastro has worked in long-term care and medical rehabilitation in the United States and since 2016 as a surveyor for accreditation of facilities in Canada. He found that in Canada “the care in those facilities is much better than in the United States, and that was in 2016 when the quality of care in nursing homes was much better than it is currently. We have nursing homes in the Commonwealth that are getting 45 and 50 deficiencies on surveys.”
While Canada has a higher proportion of facilities run by nonprofits and public facilities, the latter being practically nonexistent in the United States, Lomastro says that private for-profit facilities also provide better care. In fact, he said that he has seen facilities in both countries owned by the same corporation with very different results. “That organization in Canada did very well. All its facilities did very well. But in one particular state in the United States it had a facility under the Attorney General's receivership.”
Reasons for the Difference
Lomastro attributes the difference in the quality of care between Canada and the United States in large part to different enforcement mechanisms. The provincial health ministries in Canada have the ability to put facilities into receivership on their own initiative. In Massachusetts, the Department of Public Health would have to seek court approval, which could be a long, drawn out, expensive process.
Lomastro did mention that a new Massachusetts law, Chapter 197 of the Laws of 2024, now does give the DPH the power to appoint a temporary manager for nursing homes that are not measuring up. Whether this will be used is another question. One problem for the DPH in terms of shutting down facilities or closing admissions is that our hospitals are already burdened with patients ready for discharge with no suitable place for them to go to.
He further explained that the nursing home structures in Massachusetts are for the most part 30 or 40 years old. They are out-of-date and need repairs, but most of the owners don’t have the capital to make the updates or build new structures. In addition, many of the private facilities have been purchased by “private equity and private investment companies that have basically spun off the resource and have drained the assets out of the facility.”
Lomastro commented that one interesting difference he found between Canadian and U.S. facilities is that in Canada a much higher percentage of the senior managers were women than in the United States. Whether that is a factor in terms of the quality of care is an interesting question.
Topics
01:47 Comparing Long-Term Care in the US and Canada
03:04 Experiences and Observations in Canadian Facilities
03:26 Challenges in US Nursing Homes
05:46 Differences in Regulatory Approaches
09:05 New Legislation in Massachusetts
12:45 Financial Struggles and Facility Conditions
14:30 Public vs. Private Facilities
16:49 Nonprofits and For-Profit Entities in Healthcare
18:10 Impact of Budget Cuts on Medicare and Medicaid
19:27 Comparing Healthcare Systems: US vs Canada
22:17 Recommendations for Policymakers
25:17 Advice for Baby Boomers
26:46 The Future of Elder Care
29:44 Conclusion and Final Thoughts