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Extendicare has also announced a big share buyback, so some of the money may be used for that as well. The first reason the stock is down is likely that it had attracted a lot of "hot" money - hedge funds and other traders hoping the sale of the U.S. business would bring a quick buck in the form of a special dividend. The sale price ended up being on the low end of the expected range, which frustrated these traders. But worse, in their eyes, was that the company plans to reinvest the proceeds rather than paying out a big fat dividend.

It didn't take long for the acrimony to start flowing, with irate investors calling out management for supposedly poor decision-making. On paper, their arguments are plausible. The U.S. operations are bigger than the Canadian business, so it's easy to believe arguments that the dividend is at risk because once you take out the U.S. division there's not enough cash flow coverage for the current dividend. But that's a false argument because it assumes the $220-million net proceeds from the sale can't be put to work to generate more cash to support the existing dividend - and perhaps increase it. By way of example, Extendicare just acquired the home health care division of Revera, a smaller competitor, for $83-million. That values the assets at 6.5 times projected earnings before interest, taxes, depreciation and amortization, a good multiple. Analyst Doug Loe at Euro Pacific Canada likes the deal, noting it's a good bolt-on acquisition for Extendicare's existing home-care operations and that home care is increasingly touted by experts as a way to reduce the overall cost of health care in Canada.

Mr. Loe also believes that this acquisition goes some way to reduce the risk to the dividend. While the U.S. operations are strained by compressing margins and rising insurance costs, Extendicare still generates more than half its cash flow from south of the border. But this accretive acquisition adds about 10 cents of cash flow per share. The dividend is 48 cents, so assuming half the funds for the dividend are coming from the United States, the company has already replaced a good proportion of it with an investment of $80-million. It has another roughly $200-million to deploy so it appears that the fears of a dividend cut are overblown as long as the company can deploy funds in a reasonable way, whether by acquisition or re-investment in its existing operations to increase revenue and profits. I have to think that with an aging population and growing demand for such services, Extendicare should not have much difficulty making judicious decisions with its cash and I'm happy to collect a nice dividend while I wait to see what they do with that big war chest of cash. Fabrice Taylor, CFA, publishes the President's Club investment letter, for which he and The Globe and Mail have a distribution agreement. He holds shares of Extendicare. Extendicare (EXE) Close: $6.45, down 5C/

Despite this being a newly introduced bill, Laronde said front-line care workers at long-term care facilities in Ontario have been fighting to have this for years. "This campaign (to legislate more time for individual long-term care residents) has been going on for many years and it's finally got a bill," said Laronde. MPP Gilles Bisson (NDP - Timmins-James Bay), explained, "It's a bill that has yet to be debated. It's been introduced. We're waiting for it to be debated." The fact the bill was introduced by a the health critic of the NDP doesn't mean the Liberals will automatically shoot it down as an act of partisan politics, said Bisson.

"You don't have enough time to sit and talk with them. It's always a rush. Everything has time constraints. You have to be in the dining room by 8:30; you have to be out by whenever; you have to have a shower today - I mean, that's their home. And you actually want to sit with them and talk with them, but you just don't have the time. You can't even get to know your residents. You know them by seeing them every day but you don't really get to know their background, or their history, you know, what they did before. You try to get to know them but you don't have the time to spend with them." If Bill 188 passes, all long-term care homes in the province will be required to stafftheir facilities adequately enough to provide a minimum four-hour standard of care for each resident each day.

"There are a number of bills put forward, quite frankly, by members of the opposition that wind up becoming law," he said. "In fact, France Gélinas has been very successful in putting forward a number of private member's bills that the government adopted as their own bill." The Extendicare Timmins workers intend to hold information pickets again on Thursday and Friday. © 2016 Postmedia Network Inc. All rights reserved. Illustration: • Ron Grech, The Daily Press / Front-line care staffat Extendicare Timmins held an information picket Wednesday afternoon to express their support for Bill 188 which is currently going through the Ontario legislature. The NDPinitiated bill, referred to the Time To Care Act, would make a minimum four-hour daily care a legal standard for long-term care residents.

Extendicare is a Markham-based for-profit company that operates on both sides of the Canada-U.S. border. About 37 per cent of its revenue comes from the company’s operations in Ontario, Manitoba, Saskatchewan and Alberta. CEO Timothy Lukenda lives in Pewaukee, Wisconsin, not far from the company’s U.S. headquarters in Milwaukee. His father is a well-known dentist in the Sault and owns the junior hockey franchise in that city. Prior to getting the top job at Extendicare, Lukenda was an investment banker.

whether or not the home had failed to provide that “safe environment” was not an issue for police to investigate. “That is the exclusive jurisdiction of the Ministry of Health. They oversee long term care homes, not the police.”

Statistics obtained by W5 reveal that there were more than 10,000 resident-on-resident incidents reported at long term care homes across Canada in one year.

Extendicare has promised to do better in the future and has drafted a voluntary plan of action

Staff at long term care homes and advocates for seniors believe a major contributing factor is the ratio of staff to residents. Despite claims from many homes that the average day-time ratio is one staff for every eight patients, personal care workers interviewed for this story claim that ratio is rarely met.

“You could be one PSW [personal support worker] on a floor of 25, and if two residents start going at it, what do you do?“ said Miranda Ferrier, President of the Ontario Personal Support Workers’ Association.

The reports were taken to the University of Toronto’s Institute for Life Course and Aging for analysis. “I can say in Canada we’ve never had a study on abuse in any institution, let alone on resident-to-resident,” said Lynn McDonald, the director of the Institute. “In fact, when CTV came to me I thought ‘Oh, my goodness; this is the most data I’ve ever seen on this particular issue.’

Theresa doesn’t blame Frank’s attacker, or the staff. She blames Extendicare and has taken her story to the street, picketing in front of Extendicare’s Lakeside Long Term Care Facility

Up to 64 ALC patients have stayed at SAH at the same time. The 50 patients will be transferred over a 10-day period. "We don't want to rush it," she said. Hospital staff who work with the patients will help with the move. Thirty were in an area of the hospital typically not used. "At least 14" beds will become free with their departure, said Bertrand. "Today is another example of creating more opportunities for long-term care in Sault Ste. Marie," said MPP David Orazietti. There are now about 850 long-term care beds in the city.

The rollout of the interim beds took several years to develop, said Orazietti. North East Local Health Integration Network issued a request for proposal for a company to operate the beds in the fall of 2013, said Autumnwood president Joe DiPietro. His company was selected in the winter of 2014. Autumnwood ope ra tes three retirement residences and an apartment building in Sudbury, North Bay and Timmins. The privately-held company spent $1.8 million to renovate the former Davey Home. Improvements included new flooring, carpeting, fixtures, furniture and lighting, said DiPietro. Renovations will continue over the next two months for the remainder of the facility. That's expected to cost about $400,000. Total bed capacity is about 96.

Whether the province will fund more interim long-term care beds at Cedarwood depends on health care priorities identified in the community, said Orazietti. "We need to ensure as a government we're putting the resources in the right places so that we can balance those needs and priorities," he said. Autumnwood is employing up to 55 full-and part-time staff at Cedarwood Lodge. Positions include personal support workers, registered practical nurses, registered nurses and administration. The company, established in 1998, makes care for seniors its priority, said DiPietro.

"Absolutely 100%," he told The Sault Star. "That's the reason why we're in the business. We're not in the business for any other reason. We could have come here and literally spent half of what we actually spent in this facility and still opened the doors. It would have passed, but we didn't want to do that. We spent more money than we needed to spend to ensure that the residents had a dignified place to lay their head down at night." Dr. Al McLean is Cedarwood's medical director.

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.