‘A devaluation of human life’

Alexey Sidnev spent 15 years working to improve elder care in Russia. Then an anti-war statement cost him his job.

Shortly after Russia launched its full-scale war in Ukraine, Alexey Sidnev, the founder of a network of geriatric centers called Senior Group, took a stand against it: he and a number of other NGO representatives wrote a letter to Vladimir Putin demanding he put a stop to the war. Two months later, Sidnev was fired from his own company. Sidnev is a pioneer of Russian social entrepreneurship; he’s been working since the mid-2000s to reinvent what it means to care for the elderly in Russia. Meduza special correspondent Sasha Sivtsova spoke with Sidnev about Senior Group’s mission, competition from the state, and how the war and pandemic have changed elder care in Russia.

In the last decade and half, social entrepreneur Alexey Sidnev has arguably done more than anyone else to change elder care in Russia. While getting his MBA at Dartmouth College in the U.S. in the 1990s, he noticed American nursing homes run by corporations differed dramatically from the drab, state-owned Russian one he’d seen on a school field trip as a kid. After graduating, he spent a few years working for the consulting firm Booz & Company, taking advantage of the travel-heavy work to learn more about how various countries structure and pay for their elder care systems.

In 2007, Sidnev quit his job and moved to Moscow to start Senior Group, a private network of geriatric care centers. He’s since become an authority on Russia’s elder care system, even working with legislators to help develop a new federal law in 2015.

“According to the law, a person who needs around-the-clock care can choose what institution they want to go to, including both public or private ones,” he told Meduza. “If they choose a private one, the state is required to pay for their stay there.”

But while the Russian system’s dysfunction was a big factor in his initial decision to build his business there, he didn't anticipate the degree to which the government would work against him.

“Essentially, the government used to say, ‘Cool, we need to develop our private businesses in this sector.’ But as soon as some private initiatives actually appeared and the state faced real competition, they realized businesses are better at dealing with problems [in the social services sector] and that they’d have to allocate more of their budget to private organizations,” he told Meduza.

As a result, the law he helped write only really exists in theory — not in practice.

“Say a person reaches out to the authorities [...] and asks to be recognized as needing social assistance so that they’ll send him [...] to a private facility,” Sidnev said. “The state might acknowledge that the family needs assistance, but it won’t pay for the private facility, because it’s cheaper to put the person in a state institution. If the family wants [to put their relative in] a private center, they’ll have to pay for it themselves.”

The reasons for this, he said, boil down to jealousy and tradition. According to Sidnev, officials don’t like when private corporations show themselves to be more effective than the state.

“They have this idea that [only] the state should be allowed to open hospitals, medical centers, and nursing homes,” he said. “But how can [the state] compete with private facilities that are better? So they limit competition to ensure there aren’t high-quality private companies that make them look bad.”

One-two punch

The pandemic hit Russia’s nursing home industry hard — and for a country that generally views elder care as the responsibility of the state, the government certainly didn’t help, according to Sidnev.

“When the pandemic began, the Labor Ministry recommended we stop accepting new clients [to our elder care facilities],” he said. “At the same time, the state decreased the level of residential social services it was willing to subsidize.”

Eventually, the subsidies became so low that Senior Group found itself unable to provide quality services. They started closing down branches; residents had to either pay more and move to other Senior Care locations or go to less comfortable, state-owned institutions.

“Our expenses rose significantly [because of things like COVID-19 treatment and PPE], right as our income was falling,” he said. “Our majority shareholder, [Russian hospital group] European Medical Center, became vocal about their frustration that our company wasn’t earning as much as they had hoped.”

After Russia launched its full-scale war against Ukraine in February of this year, Senior Group’s situation became even more dire: anti-war sanctions have effectively ensured that they won’t have any more international investment offers, and they’ve also begun losing domestic investors.

“Our industry’s going to be even more dependent on the state,” said Sidnev.

'A difference in our value systems'

In early March, Sidnev and a number of his colleagues from the Russian NGO space released an open letter to Vladimir Putin condemning the war and demanding it be brought to an end. Soon after, Sidnev learned from his partner that he’d been fired. The decision had been made by the three European Medical Center representatives who made up the majority of the Senior Group board of directors. They had sent Sidnev an email to notify him, but they had also locked his email account.

“My opinion on the war differs from that of the managers who took over Senior Group’s operations after the pandemic,” Sidnev said. “It became uncomfortable for me [to work with them]; the difference in our value systems hadn’t been so obvious before. [I think, in part,] that’s why they decided to terminate my contract.”

But he also maintains that the situation isn’t that simple, and that the board did have sufficient grounds to fire him — even if their decision was ultimately a political one.

“The European Medical Center is known for its expensive services — the company makes quite a lot of money,” he said. “So if a business isn’t bringing in profit, they have every right to do what they did. As an investor, I understand it, but as a human being, I can’t. In my view, it wasn’t exactly the right thing to do. [...] I don’t want it to sound like we disagreed on the war and they kicked me out of the company because of that; Senior Group wasn’t delivering the results I had promised it would. But I do think that if my views on the war were the same as theirs, or if there hadn’t been a war, I’d definitely still be working at the company.”

But even though it cost him his job, Sidnev says he would sign the letter again if he could; in his view, speaking up was simply the right thing to do.

“Yes, it’s scary to speak out, and I could get arrested and given jail time, plus I have four kids — I’m risking not just my business but my family, too. But I couldn’t keep silent. I’ve always been that way. I just wouldn’t be able to live with myself.”

It’s also true that as an insider to the place where Russia’s government and its healthcare industry intersect, he’s long had a front row seat to what he calls the authorities’ “devaluation of human life.” In 2014, for example, the waiting list to be accommodated in one of the country’s residential care facilities garnered attention when Vladimir Putin learned it was 16,600 people long. He demanded officials solve the problem, and so they did: they stopped adding people to the lists at all, and within three years, they’d dwindled to zero.

Then in 2021, the government in St. Petersburg stopped compensating private providers for services that had already been provided. “They said it wouldn’t be a big deal if people were just transferred from comfortable private facilities to state psychiatric hospitals,” said Sidnev. “And the fact that people there die [earlier than they would otherwise] didn’t bother anyone.”

In fact, he’s convinced, prematures deaths in subpar care facilities aren’t just a necessary evil to the authorities — they’re a bonus.

“It’s cheap for the state — after all, people don’t end up staying there for very long,” said Sidnev. “[And when they die,] the state is freed from paying for their social services.”

Interview by Sasha Sivtsova

Abridged translation by Sam Breazeale