Dr. Eric Hoskin, Ontario’s Health Minister, speaks about his top four priorities at HealthAchieve November 5.
Dr. Eric Hoskins may be signing his name, but the latest Toronto Star letter-to-the-editor from the Health Minister sounds as tired and exasperated as those served up by his predecessor. Given Ministers seldom pen their own letters, we conclude it must be hard to get good help these days.
Hoskins (or his ghost writer) insists that Star columnist Bob Hepburn is wrong – that in fact no cuts are taking place in home care. Never mind Erie St. Clair CCAC’s new executive director sent out a memo announcing a 33 per cent cut in daily nursing visits or that Care Coordinators at the Champlain CCAC are beside themselves having to recommend out-of-pocket paid alternatives to long-term patients who suddenly find themselves without a caregiver. Both CCACs are staring down millions in debt and are in freefall. But hey, aren’t we glad that no cuts are taking place?
It’s the same old song and dance coming out of the Minister’s office. Hoskins insists that Windsor got $3 million more in funding this year and that overall $270 million has been added for home care. Demand is far outstripping this funding due to a planned multi-year freeze to the base budget of Ontario’s public hospitals. Care Coordinators are telling us that not only is this placing the CCACs under great pressure, but it is changing the very nature of the work they are doing. It’s all about post-hospital care, not about longer-term chronic care management and support.
In this new video Anna Jover and Emily Visser highlight the voices of several OPSEU activists during Friday’s health care rally at Queen’s Park, including President Warren (Smokey) Thomas. About 5,000 Ontarians came from all corners of the province to protest the increasing privatization of hospital-based services. Earlier this year the province began holding competitions for services provided by existing public hospitals, including diagnostics and cataract surgeries. Those competitions were suspended by incoming Health Minister Dr. Eric Hoskins, but there has been no word from the Ministry whether this is a pause or whether the competitions would begin again at a later date. Further, the government has kept secret their commissioned Deloitte study that purportedly recommends the transfer of specialized medical laboratory testing to the private sector. When the Local Health Integration Networks were established labour complained that such destructive competitions that left shortages of caregivers in home care would be extended to public hospitals. At the time the government suggested this was no more than scaremongering.
Thousands of Ontarians boarded buses in the pre-dawn hours to come to Queen’s Park to defend their public hospitals on Friday afternoon.
Organized by the Ontario Health Coalition, the demonstration was likely the largest of its kind in recent years despite the unusual cold November temperatures. Volunteers estimated the crowd at the height of the rally was between 4,000 to 5,000 people. Operation Maple’s video and our photos below. More to come on Monday.
Oshawa NDP MPP Jennifer French addresses the rally.
OPSEU Region 4 brought their new Kathleen Wynne puppet.
Marching up University Avenue after speeches at on the lawn of Queen’s Park.
OPSEU President Warren (Smokey) Thomas addressing the rally.
Between 4,000-5,000 Ontarians showed up to support their local hospitals at Queen’s Park November 21.
Nursing staff are leaving CarePartners in Niagara and Norfolk Counties as the employer thwarts efforts to secure a first collective agreement.
Continuity of care is important to the delivery of home care. Each time a caregiver changes there is a necessary rebuilding of relationships. If caregivers are continually turning over, it is much more difficult to notice changes in the patient’s medical condition. For example, if a nurse never saw a wound before, how can she or he tell whether it is healing properly? Much of the care work is intimate in nature and subsequently relationships built up over time are important.
In 2003 the not-for-profit Victorian Order of Nurses lost the Community Care Access Centre’s visiting nursing contract in the Niagara region during a year in which the community was celebrating VON’s centenary. We were told over and over that the competitions were about quality, not necessarily price.
In the subsequent contract turnover one of the companies – the for-profit CarePartners – simply could not recruit sufficient experienced staff to successfully take over care from the VON. Instead they shuttled nursing staff from other operations around the province to do what they could to shore up their contract obligations. We heard first-hand patient stories about missed visits, about an inability to contact CarePartners over the weekends, about stressed staff rushing in and out to keep up with an impossible workload.
Of those few nurses who transitioned from VON to CarePartners, in 2005 we were unable to successfully argue in court that this represented a sale of business, and subsequently those workers were unable to retain their rights or union. Many of the VON’s original staff decided to find work elsewhere.
It’s more than 10 years later and the Niagara and Norfolk County staff of CarePartners chose OPSEU to help them seek a first collective agreement with the company. CarePartners is a much larger corporation these days thanks to an initial merger with Red Cross and the subsequent purchase of Red Cross’ home support operations.
Corporate giant Revera is clawing back mileage rates from home care PSWs, potentially jeopardizing the province’s workforce stabilization plan. Photo: http://www.canstockphoto.com
Home and residential care giant Revera say they are proud to support Ontario’s wage stabilization initiative for personal support workers (PSWs). Now that their home care workers have received the $1.50/hr wage increase, the corporation is telling the non-union portion of their workforce they are clawing back 8 cents per kilometre in compensation for travel between clients. In other words, they wanted government to pick up the bill for improved wage compensation so they could trash travel compensation for the same employees. That may not be what Health Minister Eric Hoskins had in mind with the Ministry’s workforce stabilization plan.
For some workers, the Revera claw back on mileage could eclipse the wage increase, leaving the government no further ahead in improving compensation to stem the tide of PSW departures. The turnover rate for PSWs in Ontario’s home care sector is 60 per cent – or the entire workforce in less than two years. That, by any standards, does not represent good continuity of care. Given Revera professes their number one goal is to help their clients, this gives every appearance they are more concerned about helping their profits.
A $1.50 per hour increase would total $52.50 before deductions on a 35 hour week – that’s slightly more than most PSWs would receive in paid hours. The loss of 8 cents per kilometre means that the wage increase would be wiped out if the worker drives more than 656 kilometer in a week – a cumulative distance not that uncommon particularly in more rural settings. Further, the company is not reimbursing on actual kilometres travelled, but based on the “optimal” route using Google Maps. Better not divert for gas, a Tim’s coffee or to avoid traffic and construction through an alternate route.
Harvard professor Michael Porter speaking at this year’s OHA HealthAchieve.
There was an epiphany moment at this year’s Ontario Hospital Association HealthAchieve when a hospital administrator responsible for patient surveys admitted that she had been doing it all wrong. The surveys were all about the hospital’s performance, not about the patient, she said.
We are in the age of continual measurement as administrators try to reduce the business of providing health care to a series of performance data tables. One could argue that surveying patients about their care is about improving the patient experience, so one has to wonder where the sophistry ends and where practical management begins?
At this year’s conference there was plenty of angst about the role of the patient in determining how health care is delivered.
Paul Corrigan, a former health advisor to UK Prime Minister Tony Blair, made a less than convincing case that health care providers should be basing their decisions around outcomes defined by the patient instead of the health professionals. Instead of a surgeon deciding a procedure has been a success, for example, that success should be defined around whether the patient achieves his or her goal to “walk to the shops,” for example. It’s perhaps a good thing that Corrigan didn’t encounter a patient whose goal was to play piano at Carnegie Hall.
“Hearing what patients are saying would be transformative,” says Corrigan, the implication being that we don’t.
Sir Nigel Crisp, a former senior manager in the UK’s National Health Service, ramped up the rhetoric by going as far as saying “professionals need to get down from their pedestals and patients up from their knees.” Seriously?