Sure. First, nursing homes and residential long-term care generally are outside the Canada Health Act. Every province funds long-term care somewhat differently, and unlike acute-care services and doctors' services, which are publicly funded and generally—at least, hospitals are publicly delivered, for the most part. Long-term care is usually a mix. For instance, in Manitoba, 20% of all nursing homes with public funding are in the for-profit sector, and 80% are non-profit. In B.C., the distribution is 70/30. In Ontario, interestingly, it's a little the other way. It's about 60% for-profit, and the rest is non-profit. When I'm talking about that, I'm talking about facilities receiving public funding. I'm not talking about the small number of facilities that are completely outside that system whereby people pay a large amount of money every month, which really comprise a very small minority. I'm talking about public funding of different ownership models.
We have most of the evidence around that from south of the border because a very large for-profit sector receives funding there from Medicare and Medicaid in the U.S. An overwhelming amount of evidence from the U.S. demonstrates that staffing levels are lower, there's a higher rate of pressure sores.... A number of articles show there is a higher rate of hospitalization for what we call care-sensitive conditions.
In Canada, the research evidence is much slower to come in, but this is one of my own areas of research interest. We have looked at this question in the province of British Columbia with respect to levels of staffing and with respect to hospitalization for things like pneumonia, dehydration, anemia—things that one would assume, if the care were better, there would be a lower rate of hospitalization for it. We found in all those studies that generally the evidence is similar to the U.S., that there are higher rates of hospitalization in facilities that are for-profit and lower rates particularly in facilities that are public and non-profit.