Being driven by the need to generate a profit versus being driven to provide care
For-profit organizations needed to make a profit for shareholders and required their facilities to be “fiscally responsible” (SM#2). Government funding was considered insufficient, with one senior management participant saying: “the amount we get per day doesn’t look after the residents right now” (SM#1). Some facilities were not financially viable. Organizations used profits from the sale of independent units co-located in the retirement village (self-care apartments and villas) for facility operational costs however, doing so decreased organization profits. One senior management participant observed that “…unless the government recognises (the shortfall), there’s gonna be a lot of providers go out of business. Particularly those that don’t have villages. [to embed SUp in practice] We would have to actually think about how we funded it in the tight environment that we’re in at the moment”. In this financial context, physical therapist delivery of SUp was perceived as a cost. This brought tensions. Whilst valued for being “resident focused and quality of life focused” (SM#1), delivery of SUp was balanced against organizational finances, with participants saying “we have to be able to afford them [SUp classes] and not go down the gurgler” (SM#1) and “I would absolutely love to have something like this (SUp) in, but it’s the matter of the money” (SM#2). Another senior management participant discussed weighing up the increase of a resident’s wellbeing against their length of stay in a facility to determine the return on investment in SUp, “should it be an investment that we make to ensure that our rest home level care residents are more well? But then do we get them all well and they go home? (laughter) That’s one side of the coin, but the other side of it is, get them all well and more mobile so that their quality of life is better and they live longer in a lovely environment with us” (SM#3). This comment was immediately followed by an expression discomfort about basing a decision to improve a person’s quality of life on financial gain, “[it] sounds pretty horrible” (SM#3).In contrast to the for-profit organizations, the charity LTC organization received government and charitable funding. The charity required only that the organization provide care for those in need. This saw the organization foreground the well-being of residents alongside prudent financial management. Business decision-making was guided by principles of “promoting well-being” (Mgmt#5) and feedback gathered through surveys and resident focus groups. This created an environment where management did not feel financially constrained and could approach the Board for new initiative funding. The Board’s view on the positive contribution made by physical therapy to resident’s wellbeing was well known. The management participant reflected on the possibility of continuing SUp as designed if it was found to be effective, “is there a really good argument now to actually increase physio not just hold status quo” (Mgmt#5).The for-profit organizations drive for profitability meant management had an acute awareness of cost. This led to tight budgeting which constrained the uptake of any new initiatives in the absence of specific funding. The charity organization’s drive for resident well-being led to regular review of service delivery. Services were updated as part of business as usual to deliver better resident outcomes. The charity, in contrast to the for-profit organizations, had a mechanism for management to gain financial support for new initiatives if needed.