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owned by Revera, which operates retirement homes and nursing homes throughout Canada and the United States

Daniels’ relationship with the home soured about a month ago, when she found out her mother was going to be hit with new fees for services such as continence toileting or being escorted to the dining room.

Those services have been costing $478 a month on top of the $2,774 she pays for accommodation and food. The same care services will rise to $2,271 in September for a total monthly charge of $5,045.

Revera says it is introducing an “à la carte” service for all residents in its Ontario retirement homes to cover its costs.

Daniels says her mother is receiving all those services now for about one-fifth of the price. “It just boggles the mind,” she says.

The new fees don’t apply to Revera’s Ontario nursing homes because monthly rates for such facilities are determined by the provincial health ministry. But the ministry does not regulate fees for retirement homes or their long-term care components, so Provost and others living on Westwood’s two long-term floors are sitting ducks.

Bernard Bouchard, executive director of the Council on Aging of Ottawa, says he believes Revera is trying to make up some of its extra costs from new licensing regulations brought in by the Ontario government in April 2011. As well, he says, operators are trying to find new revenues as retirement homes are operating at about 80-per-cent capacity.

Daniels says her mother will have to move to a nursing home. And there lies another problem. She will have to go on a waiting list because nursing homes are full.

having a staff member escort her mother, who uses a walker, to the dining area and back to her room three times a day will cost $606 a month. Helping feed her when she needs assistance is another $252. Checking her room twice nightly, to see if she has fallen out of bed or needs to go to the washroom is $168. Continence toileting is $673.70. She will also be charged an additional $505 monthly for general staff assistance.

they said: ‘We can look after her, we have palliative care. She can stay here until she dies.’ ”

Ontario seniors homes have the worst fire fatality record in North America with 45 deaths since 1980.

Four private members’ bills and three inquests have all recommended sprinklers.

Residences built after 1998 must have sprinklers but the devices are still not required in 4,000 older “care occupancies,” which house more than 200,000 seniors and other vulnerable people across Ontario including the intellectually challenged. The frail, elderly are more likely to die in fires than any other age group, experts say.

Madeleine Meilleur, Minister of Community Safety and Correctional Services

“Sprinklers are not the only answer. They are important, but nothing will replace the staffing levels and how they are trained in case of fire,”

There are never fire deaths in homes with sprinklers except in the rare case where a person who caused the fire is overcome by injuries, said Sean Tracey, of the U.S.-based National Fire Protection Association.

Ontario fire chiefs are frustrated with the province’s refusal to force homes to install sprinklers that would protect the elderly. The fire chiefs say their study is the latest effort in a long campaign to convince Queen’s Park.

an early draft said most respondents (more than 230 comments came from firefighters, retirement homes, municipalities and advocates) agreed that sprinklers should be mandatory in all care homes.

Oak Terrace long-term care home, a government-licensed nursing home operated by the Revera chain, failed a test in October 2010.

After fire officials sent a letter to each member of Revera’s board of directors, the home decided to install sprinklers

Revera has installed sprinklers in 85 per cent of its 200 retirement and nursing homes across Canada

Homes that fail mock evacuation tests are hit with legal orders under the Fire Prevention and Protection Act, telling them to hire enough staff to be able to safely evacuate 24 hours a day — or install sprinklers.

Sprinkler installation costs roughly $3 a square foot. That translates to $40,000 for a 30-person home or about $110,000 for a 155-person home.

Fragile residents, combined with inadequate staffing and the fiery nature of materials in modern furniture, like the foam padding in couches, are a recipe for disaster.

In 2010, a year after the Orillia fire killed four residents (and left two brain dead), the government began a consultation on fire safety. Meilleur said she expects the report will be released in June.

Here is how the chiefs did the study: Firefighters visited a retirement or nursing home — sometimes without advance notice — and performed a mock evacuation based on the number of overnight staff when few employees are on shift. Firefighters ordered staff to conduct a fire drill. Using a stopwatch, they tested staff’s ability to move residents out of the building or behind a firewall

“If 45 children had died in fires would we still be waiting for the government to take action?”

residents, some drugged for a night’s sleep

An elderly woman with a broken thighbone in a Pickering nursing home suffered for days without treatment.

A Brantford home was so short staffed that residents frequently missed their weekly baths.

Eight years after an Ontario government promise to revolutionize nursing home care, the elderly are still suffering neglect and abuse.

The Star’s investigation draws from material uncovered by a new inspection system created by the Ministry of Health and Long-Term Care in July 2010. It has since investigated 2,993 complaints and critical incidents, like broken bones or assaults. We analyzed more than 1,500 of those inspection reports and found at least 350 cases of neglect where residents were left in soaking diapers, suffered untreated injuries, bedsores, dehydration, weight loss or were put at risk from outdated care plans that ignored changing medical needs. Other reports, scrutinized for Thursday’s story, focused on abuse. Today the Star probes the issue of neglectful treatment of home residents. The reports reveal that many families have no idea what their loved ones are subjected to. Inspectors found that some homes do not disclose problems to the ministry or police.

Diaper shortages can be found in many of Ontario’s 627 homes, said Sharleen Stewart president of the union representing front-line nursing home staff. “Our members tell us the shortages leave residents with rashes and sores,” said Stewart, of the Service Employees International Union, which represents 50,000 Ontario health care workers, including 22,000 nursing home employees.

Last November a ministry inspector wrote, “Five different nursing staff members working the day shift from all home areas… indicated they are only provided with one (diaper) per (eight hour) shift for the resident and frequently have to go to another home area to try and borrow products.”

The report also described a resident with an open sore whose diaper was soaked in the morning. Since staff could not find a replacement, the resident was only given a paper insert to keep urine from the senior’s wound.

Two months later, in January 2011, the ministry was back at the same home, this time investigating a complaint from a family who said their loved one was wearing the same diaper from the previous day and it was “heavily soiled.”

Ko dismissed allegations that a Revera home in north Etobicoke rations diapers. But one current and one former resident of Westside Long Term Care on Albion Rd. told the Star residents are only given one diaper per eight-hour shift.

She praised the staff, saying they scramble to find an extra diaper if one’s needed. “They’re embarrassed that I’m embarrassed.”

Two employees at Westside said the home locks up diapers and staff have to sign them out. The workers at Westside spoke on the condition of anonymity, saying they are afraid of being fired. One worker said she is so worried about leaving residents in wet diapers that she places towels and plastic garbage bags under them to prevent urine from soaking their bed sheets.

Revera was “shocked” to hear allegations that makeshift diapers were being used and she has both launched an investigation and is conducting educational sessions for staff

Westside workers say their bosses warn staff they will be fired if they tell residents’ families the home is rationing diapers. Whistleblower protection in Ontario homes only helps staff who divulge problems to their nursing home supervisors or the health ministry. It does not protect the jobs of workers who warn residents’ families that their relatives are being neglected, complain to their union or speak to the media.

The new inspection report system often hides bad care from public scrutiny. The public report is often stripped of details. A private version for the home’s management, on the other hand, gives precise information about each violation. It took Lorraine Henderson 11 months to obtain copies of these private reports through access to information legislation.

The Star’s analysis of inspection reports found more than 50 cases in which elderly residents fell and got injured, many times when they were left unassisted by caregivers or dropped from mechanical lifts.

About five per cent of B.C. seniors — and 10 per cent of those over the age of 75 — live in health care facilities like hospitals or residential care homes, according to 2006 numbers

The three largest contractors — Retirement Concepts, Revera Long Term Care and Ahmon Group — receive about 10 per cent of the total funding, or about $162 million.

the daily nursing hours per resident at a facility operated by a health authority was about 3.30. That compares to 2.48 hours at a non-profit, and 2.13 at a for-profit facility.

Provinces like B.C., Alberta and Ontario increasingly rely on the non-profit and private sector to put up the capital to build new residential care facilities.

The Compass Group, often described as the world's largest contract food services company, locked out over 200 workers at seven B.C. long term care homes on Sept. 29.

just over $12 an hour

without a contract since December 2010

Steelworkers local 2009

At Arbutus Care, as around the world, Compass provides contracted food services to the facility's owners, in this case the Revera company.

come in early and work through our breaks to get our work done

We are all working very hard and we deserve more than a raise of five cents an hour.

casual status

ineligible for the benefits

Compass is paying less than other contractors in the sector

Compass was listed in 2010 as one of the Fortune 500 top global companies, ranked as number 424 in that elite listing. It is listed as number nine in an online article about the globe's largest employers last year, ranking just behind the Agricultural Bank of China and just ahead of IBM.

still generating profit of over a billion English pounds

The Canadian division of Compass, which in 2010 employed over 23,000 "associates," generated $1.4 billion in revenue.

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/