What did we learn about Ontario long-term care corporate governance?
Early in the project’s development—before we even gathered data—we observed significant differences in the corporate governance of long-term care organizations in Ontario. Although centrally regulated under the Long-Term Care Homes Act, 2007, and as discussed earlier in this report, the provincial system for facilities-based care includes a patchwork of different service providers that are licensed to operate long-term care homes (see Figure 1 for a breakdown, by organizational type).
Each of these organizational types—whether by unique tradition or by varying applicable legislation—is defined and steered by a variety of different corporate governance structures and processes. For example, municipal long-term care homes in Ontario are under the authority of local municipal governments, in which the city council (typically a mayor and councillors) provides the highest level of oversight—via “overall stewardship of the municipality”—and “monitors the implementation of its approved policies and programs” (Ministry of Municipal Affairs and Housing, 2021). In private for-profit homes that are also publicly traded on a stock exchange, the board has legal obligations to its shareholders. And, the board members of non-profit and charitable homes are often volunteers, while the directors of other organizational types can be compensated for their board work.
These are just a few of the differences between long-term care organizations, through the lens of corporate governance. Each home has unique organizational needs and obligations, and serves and is accountable to a unique group of stakeholders and authorities. And yet, even with these differences, all long-term care providers in Ontario—regardless of organizational type—deliver (generally and broadly) the same services to the same population group, within the same funding structure and under the same legislation.
With these unique constraints and organizational juxtapositions at play, we were very curious to learn more about how long-term care organizations govern themselves. Recognizing that the data we collected—and the analysis shared in this report—represents only a glimpse into the long-term care landscape in Ontario, participant responses to our survey and interview questions helped us begin to understand what corporate governance looks like in long-term care organizations. We uncovered three insights.