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Some $445 million worth of commodities are sent for processing each year, a nearly 50 percent increase since 2006.

The Center for Science in the Public Interest has warned that sending food to be processed often means lower nutritional value

A 2008 study by the Robert Wood Johnson Foundation found that by the time many healthier commodities reach students, “they have about the same nutritional value as junk foods.”

Roland Zullo, a researcher at the University of Michigan, found in 2008 that Michigan schools that hired private food-service management firms spent less on labor and food but more on fees and supplies, yielding “no substantive economic savings.”

privatization was associated with lower test scores, hypothesizing that the high-fat and high-sugar foods served by the companies might be the cause

in 2010, Dr. Zullo found that Chartwells was able to trim costs by cutting benefits for workers in Ann Arbor schools, but that the schools didn’t end up realizing any savings

Why is this allowed to happen? Part of it is that school authorities don’t want the trouble of overseeing real kitchens. Part of it is that the management companies are saving money by not having to pay skilled kitchen workers.

In addition, the management companies have a cozy relationship with food processers, which routinely pay the companies rebates (typically around 14 percent) in return for contracts. The rebates have generally been kept secret from schools, which are charged the full price.

Last year, Andrew M. Cuomo, then the New York State attorney general, won a $20 million settlement over Sodexo’s pocketing of such rebates. Other states are following New York and looking into the rebates; the Agriculture Department began its own inquiry in August.

the rebate abuses are continuing, now under the name of “prompt payment discounts,” under an Agriculture Department loophole

New York State requires rebates to be returned to schools, but the Sodexo settlement shows how unevenly the ban has been enforced.

Dorothy Brayley, executive director of Kids First, a nutrition advocacy group in Pawtucket, R.I., told me she encountered resistance in trying to persuade Sodexo to buy from local farmers.

The Agriculture Department proposed new rules this year that would set maximum calories for school meals; require more fruits, vegetables and whole grains; and limit trans fats.

the most committed foes of the rules are the same corporations

Their lobbying persuaded members of Congress to block a once-a-week limit on starchy vegetables and to continue to allow a few tablespoons of tomato sauce on pizza to count as a vegetable serving.

One-third of children from the ages of 6 to 19 are overweight or obese.

“The company, a for-profit corporation that receives funding from the province, made a decision to lower its wage bill to protect profit,” said Hospital Employees’ Union communications director Mike Old.

At Malaspina, care aides earn about $22 an hour under HEU’s current agreement. In non-union workplaces, a care aide’s hourly wage drops to about $15 an hour, Mr. Old said.

Nanaimo Seniors Village laid off union staff in order to hire contract workers in 2007

In 2010, Ladysmith's Lodge on 4th laid off about 140 unionized workers and contracted out their positions.

all three of the facilities in the region that have used Bill 29 to hire cheaper staff have some kind of contract with the Vancouver Island Health Authority to provide beds

At Chartwell, a chain of 27 homes, chief operating officer Karen Sullivan said the pharmacy that services the chain, MediSystem, pays for "many additional valued-added services" such as employee education, nurse leadership sessions and conferences for leaders of homes. MediSystem also pays for Wi-Fi systems and therapeutic care equipment at the homes, Sullivan said in an email. The Star asked pharmacies what they are told the money is used for. Among the responses from pharmacies were "staff education," "resident programs" and payments toward Wi-Fi systems. Classic Care, a pharmacy, said the money it pays covers monthly rent of an area in the nursing home, staff education, technology and "donations and sponsorships" for conferences and other training. Other pharmacies, such as Rexall, say their fees have paid for diabetes education, for example. The largest pharmacies serving long-term-care homes in Ontario include Medical Pharmacies Group, MediSystem (owned by Loblaw), Classic Care (Centric Health) and Rexall. The fees are not new. Pharmacies have willingly offered money or agreed to demands for years. But there's a growing outrage among some who say homes are more interested in "inducements" than "clinical excellence" that pharmacies can provide seniors. Last year, after the Ontario government cut each dispensing fee by $1.26 (it is now $5.57 per prescription in nursing homes), sources said some pharmacies wanted to stop paying the fees. The problem was, the sources said, that the homes refused to give up the extra cash flow and other drug companies were willing to pay, so nothing changed.

It's usually the larger companies that can afford to pay. One insider said smaller pharmacies now ask the homes, "Do you want the money or do you want good service? Because we can't afford to give both." Sources said the Ontario Ministry of Health and Long-Term Care knows the money changes hands but does nothing to stop it. Instead, pharmacies are "held hostage" by the homes, the source said. One home that no longer charges the fees is John Noble Home in Brantford, a municipally operated 156-bed facility. The Star obtained a 2010 request for proposals (RFP) that noted "only proposals with a minimum rebate of $20,000 annually will be considered for the project." A spokesperson for the city said the RFP "references a previously approved practice employed by several long-term care homes." A recent RFP did not ask for a rebate, though some offered to pay. The city spokesperson, Maria Visocchi, said it chose a pharmacy that "demonstrated qualifications and experience, project understanding, approach and methodology, medication system processes and quality control." This pharmacy did not offer a rebate. Not all pharmacists pay. Teresa Pitre runs Hogan Pharmacy Partners in Cambridge and serves long-term-care homes that don't ask for money. Instead, she signed contracts with several homes in the People Care chain to provide a "highly personalized approach." Pitre sends a registered pharmaceutical technician into each home daily to relieve nurses of much of their work regarding medication, confusion over communications and extensive paperwork. Her company also puts a bookshelf-sized dispensing machine in each home, which holds medication (pain relievers, antibiotics or insulin) that residents need on short notice but, in the traditional system, often can't get for hours. "I really wanted our pharmacy to be a partner with homes instead of servicing them and just meeting the requirements," she said. Meadus says the added cost of bed fees means pharmacies have no reason to reduce their rates, either by lowering dispensing fees or not charging the $2 co-payment.

A recent Star story revealed that pharmacies serving nursing homes typically charge dispensing fees for drugs once a week, rather than once a month as they typically do in a community pharmacy. Long-term-care pharmacies told the Star they charge the weekly fee because the medication for frail residents can change weekly. That was a claim hotly disputed by some family members the Star spoke to, including Margaret Calver, who has spent years documenting the costs of dispensing fees at Markhaven Nursing Home, where her husband is a resident. "This needs oversight and that's the problem," she said. "Nobody is doing the checks and balances." Moira Welsh can be reached at mwelsh@thestar.ca.

B.C.-based Ahmon Group operates Stanford Place, which was approved as a private-public partnership for construction by VIHA in 2006. It opened in 2008, months before the financial markets collapsed and the credit crunch took hold.

Financial projections for the facility were based on 100 per cent occupancy.

In January 2010, Ahmon imposed a five per cent reduction in wages, as well as a 25 per cent cut in vacation leave accrual and a 33 per cent reduction in sick leave, Old said.Later that year, the Parksville workers joined the HEU and voted for a strike to win a first collective agreement. In June, the Labour Relations Board imposed a mediation-arbitration process.

Separately, more than 150 health-care workers at Malaspina Gardens in Nanaimo have learned that their employer - Chartwell Seniors' Housing REIT - intends to contract out their work, according to the HEU.

The mediator's ruling means workers must accept wage and benefit cuts to keep Ahmon Group, the facility's private operator, in the black.The decision means that some employees' wages will be cut by as much as $3 an hour.

And because workers essentially have no successorship rights to jobs they may have worked for numerous years, we get such atrocious results like employees at Nanaimo Senior's Village getting their contracts flipped five times.

Mr. Manji puts the average current Amica resident at about 82. He predicts that age will drop to the mid- to late-70s in the coming decade

For Toronto-based operator Chartwell Seniors Housing REIT, which offers accommodation ranging from independent living to long-term care, future growth is also about providing intriguing activities to occupy increasingly-active seniors.

Amica, which caters to the wealthier subset of the market

the $3,500 to $6,000 in monthly fees charged by their residences

“Over the last decade or so, we’ve witnessed a paradigm shift to creating environments that are no longer places where you go to die, but … offer the equivalent to cruise ship living on land.”