Long-Term Care As A Social Responsibility Without Financialization

Abstract

Since the 1980s, neoliberal influences have pushed the privatization of social services, including long-term care (LTC), that has made financialization particularly possible in an expansion of the financial capital in everyday life. Research has shown that the interactive process of privatization and financialization has emerged through public-private partnerships. This partnership has undeniably created a penetration of private investment into LTC sector under the facade of expanding supportive housing and care for seniors and residents. This penetration means that financialized care providers as corporations are regularly making compromises for profit-maximization at the expense of the provision of care. It intensifies devaluation of care through exploitation of the caregiving workforce dominated by racialized and female workers, who are frequently casualized and underpaid. It has also made care more than ever as commodified personal services to shore up health systems that deprive Indigenous peoples and the disadvantaged of quality, trauma-informed care. 

This devaluation is premised on neoliberal economics which regards care as personal services, or “nurturance” of a feminine virtue, that is valued when it involves transactions. This has contributed to government policies, including Ontario’s Bill 7, the “More Beds, Better Care Act, 2022,” favoring privatization and urban bias. This legislation allows hospitals to charge Alternative Level of Care patients $400 a day for refusing to move to a LTC home of not their choosing albeit it is up to 70km away from their preferred location in southern Ontario, mostly urban, and 150km in the north, mostly rural. Also, it permits more beds to corporate care operators regardless of legal challenges and criticism for their poor care and COVID-19 related death.

Bill 7 may serve the interests of political and economic elites in profitability in Ontario, where there are widespread experiences with trauma that is intergenerational due to colonialism giving rise to oppressions, systemic racism, violence, discrimination and marginalization. Indigenous peoples, who have experienced historical trauma, value care as a collective effort that is accessible equitably for all. For Indigenous peoples, care is social by nature because it is relational and is oriented towards healing among members of the community that exercise self-determination to achieve well-being in all dimensions from physical, emotional, to mental, psychological, social and spiritual. Building on this perspective, trauma-informed care, emphasizing healing as individuals and as the (First Nation) community, is the Indigenous meaning of quality care, also known as wrap-around care. It entails community-oriented, team-based services, involving multi-sectors, in response to comprehensive and wholistic needs. 

This study adopts feminist political economy in a historical analysis of financialized LTC. It is distinct from, but in dialogue with, existing research on LTC and financialization as it explicitly brings in the Indigenous perspective of care in discussions of health financing and delivery, city development and planning, and municipal governance. This Indigenous perspective that is oriented towards wholistic healing helps envision a wide range of policy changes to achieve long-term trauma-informed care as a social responsibility and a political practice. LTC as a social responsibility leads to a sharp critique of financialization but a support to the promise of LTC as public good that cannot be fulfilled without eliminating its reliance on the devaluation and deprivation of care and financing through mortgage debt. As public good LTC can be cost-shared among different levels of the government and managed locally by municipalities and communities collectively. Thus, definancialized LTC is a political practice, rather than a market service, whereby Indigenous and racialized communities are centred and participate in the negotiation of delivery of quality care together with caregivers’ associations and unions at the community level. It is the exercise of self-determination by citizens’ groups at the community level that can democratically decide on the health needs and the delivery of quality care. This practice overcomes urban bias in access to care in metropolitan versus rural areas at the core of urban-rural and intra-urban spatial justice discourse. It upholds the right to age in place and in one’s own community in a two-pronged strategy. 

The paper recommends the two-pronged strategy to enhance city development and planning of the essential social infrastructure such as the definancialized LTC and to promote the definancialized and municipally and community-led LTC model as a precondition for just, inclusive and age-friendly living. This strategy begins with LTC as a pillar of inclusive city development and insists that LTC facilities and their financing are essential social infrastructure in city-region planning (alongside housing, transit and so on). The case study of Cassellholme that functions as regional care infrastructure for Nipissing District and reduces pressure on hospitals and urban systems points to the need to strengthen regional planning, municipal finance, and city-region resilience. The case study as a concrete illustration of definancialized LTC promotes cross-municipal governance and public accountability including investing in quality care, contributing to broader community services, and servicing Indigenous communities.