Home Care: Giving and taking away

ParaMed staff picket outside their Pembroke office in July. 140 Renfrew County home care workers could be on strike as soon as September 2.

The government gives, the home care agencies take away.

Many of OPSEU’s home care agencies are presently at the bargaining table.

You’d think this would be the best of times for the professional and support staff that conducts the often difficult work of caring for Ontario’s homebound frail and elderly. Retaining this group of workers is also important to government bean counters who can add up the cost of lengthy stays in hospital by alternative level of care patients waiting for home care access.

Clearly of all sectors, home care has also become central to the government’s strategy to migrate services into the community.

So why can’t they get it right?

Ontario did recognize there is a significant problem with recruitment and retention in home care, taking what appeared to be a bold step towards increasing specific funding for the sector’s personal support workers (PSWs). PSWs delivered 72.3 per cent of all home care visits in 2012/13 and that percentage is growing as visits by licensed health professionals (nurses, dietitians, social workers and therapists) have been in decline over the past decade.

As we noted yesterday, the turnover is so high among home care PSWs that often the entire staff of an agency can change in less than two years.

Anecdotally this was borne out earlier this year when we discovered that among VON PSWs in Owen Sound very few had spent more than two years on the job. There was little mystery why — some told us they were planning to leave because it was too hard to sustain themselves and maintain a vehicle on the wages and mileage they received.

As the government makes adjustments to improve the working life of PSWs, the home care agencies are now at the bargaining table looking for concessions. That means the government and its contract agencies are essentially rowing in opposite directions. Dr. Eric Hoskins, Ontario’s new Minister of Health, might want to seek some answers why.

Part of the answer may lie in the scale of effort.

In 2013 Home Care Ontario had recommended that “government should increase the compensation framework to reflect the value placed on the sector.” That specific recommendation included an increase in the minimum wage for PSWs, an increase to the benefits package and better travel compensation. Those recommendations much more closely resembled Elinor Caplan’s 2005 advice stemming from her Ministry-sponsored review of competitive bidding in home care.

The overall HCO compensation improvements far outstripped what the government is presently implementing. HCO never contemplated excluding PSWs who delivered home support, as the government has done. With universal wage increases, improved travel compensation and enhanced benefits, Home Care Ontario estimated the cost of its proposed compensation improvements at $470 million – a much larger investment than the $130 million that will be used to only bolster wages for Personal Care PSWs by 2016.

If a PSW doesn’t get paid for travel time, has to pay out-of-pocket for increased gas and car maintenance costs, and has fewer sick days, it’s not hard to see how the $1.50 an hour raise this year will quickly evaporate.

Instead of getting it right, the government’s austerity agenda may be counterproductive. It may leave patients to seek care in more expensive public venues without a stable workforce in the home care sector.

What is hard to understand is why Home Care Ontario and its health care provider membership are not pushing back at government? It is disappointing that they should choose to pressure workers for concessions at the bargaining table contrary to their own advice to the Minister of Health.

Clearly something’s gotta give, and it isn’t the workers’ collective agreements.

The situation is not exclusive to PSWs. A McMaster University study noted that between 1998-2004 the community health sector lost 27 per cent of its nursing workforce due in part to wage differentials with other sectors. Service by therapists has also been in significant decline, especially among physiotherapists. In 2012/13 Ontario saw a decline of more than 100,000 home care visits for publicly delivered physiotherapy compared to 2005/06.

Community Care Access Centres should be concerned about their ability to meet the needs of patients while facing potential labour disruption this fall.

Renfrew County could be the first as ParaMed Home Healthcare is taunting its workers to strike if they refuse to accept an extended five-year wage freeze. ParaMed is even refusing to bargain in advance of the September 2 strike deadline, guaranteeing that the Champlain CCAC will be scrambling to fill the void left by 110 home care professional and support staff left on the sidewalk.

Dr. Hoskins needs to recognize the centerpiece of the government’s reform effort is on shaky ground without the workers to carry it out.