Inside the opaque world of Nova Scotia's private nursing home contracts

When Edith MacLeod's family moved her into a private long-term care home outside Halifax three years ago, they signed a thick admissions packet without ever seeing the service agreement between the operator and the provincial health authority. The contract that dictated her daily care hours, the staffing ratios her nurses were required to follow, and the penalties for failing to meet them remained, like the terms for hundreds of other residents across Nova Scotia, locked inside a filing cabinet in a government building that no member of the public has been allowed to open. Learn more about A Origem Do Cafe No Brasil E Seu Impacto Economico 0052.

The private nursing home sector in Nova Scotia has grown into a multi-hundred-million-dollar network of facilities housing roughly 6,800 residents, most of whom are funded in significant part by the provincial government. Yet the contracts that govern how these for-profit and non-profit operators deliver care, what they are paid, and what they must deliver in return have become some of the most poorly documented public expenditures in the province. Freedom-of-information requests routinely return heavily redacted pages, with entire financial schedules and quality clauses blacked out.

This investigation, drawn from months of document review, interviews with former inspectors, current care workers, and families, and a cross-reference of corporate registry filings, attempts to lift that veil. It is part of a broader pattern in which essential public services are signed away in language the public cannot read. The story of how Nova Scotia's most vulnerable residents are cared for, and at what cost, is being written in terms the public is not permitted to see.

What follows is not a celebration of transparency, because very little exists. It is a record of what can be pieced together from the fragments, and a comparison with jurisdictions like Australia, where similar fights over aged care contracts have unfolded, sometimes more publicly, and sometimes with greater consequence.

The contract veil and how it was built

Nova Scotia began contracting out significant long-term care capacity to private operators in the 1990s, a wave that mirrored policy shifts across Canada as provinces sought to shed the capital costs of building new facilities. What began as a handful of pilot projects has become a parallel system in which roughly 40 percent of the province's nursing home beds sit outside direct public ownership, operated by companies ranging from small family-run non-profits to subsidiaries of publicly traded Canadian real estate trusts.

The legal architecture is built on what provincial officials call "Master Service Agreements," combined with site-specific schedules. The master agreements set the broad financial and reporting framework, while the schedules, which contain the operational specifics, are where the real detail lives. These schedules typically run for several hundred pages and include staffing grids, complaint procedures, performance metrics, and the formulas by which the province pays operators per resident per day.

The problem, according to former health authority staff who spoke on condition of anonymity, is that the schedules are treated as confidential commercial information. Even members of the legislature, when they have requested copies, have been told that disclosure could prejudice the operator's financial position. The result is that a sitting MLA cannot compare the staffing requirements at one for-profit home with those at another, and a family trying to choose between facilities has no way of knowing whether the home down the road is contractually required to provide more direct care hours than the one across town.

A familiar story for Australian readers

Anyone who has followed the rolling aged care crisis in Australia will recognise the pattern. In New South Wales and Victoria, the private aged care sector accounts for the majority of operational beds, and the contracts between providers and the federal government have been the subject of years of litigation, senate inquiries, and a Royal Commission. The Royal Commission into Aged Care Quality and Safety, which delivered its final report in 2021, found that the opacity of funding arrangements had contributed to systemic understaffing and, in dozens of cases, preventable deaths.

The parallels extend beyond disclosure. In Melbourne, the collapse of several homes operated by companies with complex offshore ownership structures prompted calls for a public beneficial ownership registry, a measure that Australian advocates say would have revealed the chain of command behind decisions that affected residents' meals, medication rounds, and shower schedules. In Adelaide, the Oakden scandal exposed how a facility could rack up years of compliance failures while still receiving government funding, because the reporting mechanisms were weak and the contracts were not publicly auditable.

Nova Scotia's situation is different in scale but familiar in shape. The province has not held a Royal Commission-style inquiry into its long-term care sector, though the COVID-19 outbreaks that tore through several private homes in 2020 and 2021 prompted a provincial review that stopped short of examining contract structures. Without that examination, the same questions that Australian families, workers, and policymakers have asked, about who profits, who decides, and who is accountable, remain largely unaddressed on this side of the Pacific.

Following the corporate money

Piecing together who actually owns and profits from Nova Scotia's private nursing homes requires a kind of investigative archaeology. The companies that hold the operating licences are often locally named, with reassuring Maritime roots, but a look at corporate registries in multiple jurisdictions shows a different picture. Several of the largest operators are subsidiaries of real estate investment trusts or holding companies headquartered in Toronto, Montreal, or, in a smaller number of cases, the United States.

These structures allow operators to separate the real estate, often the most valuable asset, from the operating company that delivers care. The property is leased back to the operator at a market rate, shifting profit from the care-delivery side of the business to the property side. The province, which funds the operating costs, ends up effectively subsidising both the care and the rent paid to an affiliated landlord. None of this is illegal, and some of it is openly disclosed in annual filings, but the contracts that govern these arrangements, including the rent formulas and the conditions under which the operator can be replaced, remain confidential.

This kind of cross-jurisdictional ownership is not unique to healthcare. Researchers tracing the Brazilian coffee origins and the economic structures that grew up around the trade have documented how complex webs of investors, landholders, and intermediaries can obscure who actually benefits from a commodity. In long-term care, the commodity is not coffee but a government-funded bed, and the opacity serves similar interests: keeping the public from seeing exactly how public money flows into private hands.

The human cost of hidden agreements

Behind the contracts are people, and it is here that the consequences of opacity become hardest to ignore. Personal support workers, the backbone of the long-term care workforce, describe staffing grids that feel theoretical, drawn up in office buildings and never adjusted for the realities of a shift. A worker in a Cape Breton home, who asked not to be named for fear of losing her job, said that on a recent weekend the facility was short four workers and that the contract's minimum staffing ratio was only met on paper because the team lead was counted as a direct care provider even though she spent most of the day coordinating phones and families.

Families describe similar gaps. A daughter who moved her father from a Toronto-area home back to Nova Scotia last year said she was stunned by the contrast in what was promised at admission and what was delivered day to day. She had assumed, she said, that the contract between the operator and the province guaranteed a baseline of care. When she asked to see the contract, she was told it was not available to residents or their families. She has since joined a small advocacy group pressing the province to publish the staffing schedules attached to each home.

Inspections, which are supposed to be the public's window into the quality of care, offer a limited view. Inspection reports are published, but they capture a moment in time and rarely reference the contractual obligations that the operator has signed. A home can pass an inspection while still falling short of the staffing hours it has committed to in its schedule, because the inspection looks at outcomes rather than the contract's letter.

Pushing back against the secrecy

The campaign to open up these contracts has been slow, and it has not always been popular with the operators themselves, who argue that disclosure would put them at a competitive disadvantage and could complicate negotiations with their own staff. Those arguments have carried weight with successive governments, which have tended to treat the sector as a partner rather than a contractor accountable to the public.

Yet the tools to change the picture exist. Other Canadian provinces publish at least summary versions of their long-term care contracts, and Australia's aged care system, for all its problems, maintains a public database of approved providers, their ownership structures, and the outcomes of their accreditation audits. A Nova Scotia registry that included the operating company, the parent entity, the real estate owner, and the site-specific staffing schedule would not resolve every problem, but it would give families, workers, journalists, and MLAs a baseline of information that has been missing for decades.

The push for such a registry has gained some momentum in the past year, aided by a broader conversation about public procurement transparency in areas far beyond healthcare. The same instincts that have led citizens to demand clearer reporting on the Cape Breton electricity rate hike are now being applied to the contracts that govern who cares for the province's elders, and under what conditions. It is a fight that will not be won quickly, but it is one that has begun.

If you have documents, contracts, or experiences you would like to share with the J. B. McLachlan Media Collective's ongoing investigation into private long-term care in Nova Scotia, reach out through our secure tip line. The contracts may be hidden, but the people affected by them are not, and their stories deserve a public record.