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Why study long-term care corporate governance?

For over 20 years, the Johnston Centre has been the University of Toronto’s home for research and insights about corporate governance. Last year, we ventured for the first time toward the study of long-term care, to learn more about how organizations offering facilities-based care in Ontario govern themselves.

Corporate governance can be defined as the structures and processes that are used to make decisions in an organization. One of the most common structures is a governing body, a group of people that have been given the authority to make decisions. A board of directors is one example of a governing body. While the duties and responsibilities of the board can vary, it is generally responsible for ensuring that management—including the CEO—is accountable for its decisions in implementing a strategy that has been approved by the board itself. A board of directors has the highest level of oversight in an organization.

We were motivated to take a closer look at corporate governance in long-term care for two key reasons: 1) public scrutiny on long-term care organizations in Canada and globally, which increased during the COVID-19 pandemic, and 2) a knowledge gap in publicly available information on long-term care corporate governance, which we observed during the early stages of our research. Each motivation will be discussed in further detail in this section.

The COVID-19 pandemic has disproportionately affected long-term care home residents in Ontario. While only 2% of total cases in the province have occurred among long-term care home residents (between January 15, 2020 and April 9, 2022), 35% of deaths from the virus were among residents of long-term care homes (Public Health Ontario, 2022). The pandemic revealed and exacerbated vulnerabilities and gaps in the long-term care sector, highlighting inadequate staffing, funding, and infrastructure, and the risks of the care of older persons and of care in congregate settings (Applegate & Ouslander, 2020; D’Adamo et al., 2020; National Collaborating Centre for Methods and Tools, 2020).

At the Johnston Centre, the impact of the pandemic on long-term care home residents prompted questions around decision-making and oversight within long-term care organizations, including the structures and processes that constitute corporate governance.

Ontario long-term care organizations support and care for nearly 80,000 people (CIHI, 2021b). However, the discussion of corporate governance structures and processes within long-term care organizations is notably absent from discourse in both corporate governance research and long-term care research, which we observed when conducting a preliminary literature review in the early stages of the project. Very little research has been disseminated regarding how long-term care organizations govern themselves, within or beyond regulatory requirements.

This information scarcity spurred our curiosity, as we formulated research questions that included What does corporate governance look like in Ontario’s long-term care organizations? Are there differences in corporate governance among long-term care organizations? How does long-term care corporate governance compare to other sectors?

While we did not expect to conclusively answer all our research questions, we aimed to spark further investigation that continues to address the knowledge gap we have observed in the study of long-term care organizations and of corporate governance. Ultimately, the intended outcome of our project is to share useful information about the corporate governance landscape of long-term care in Ontario, including insights for long-term care leaders that can support their decision-making and oversight.

Next » APPROACH: How did we study Ontario long-term care corporate governance?