Earlier this spring the Health Minister extended the moratorium on competitive bidding for service contracts in home care. She did promise that the controversial system would eventually return.
Reading this week’s report by the office of the Auditor General of Ontario, one has to question why she is not looking at alternatives.
While there have been some providers itching to see a return to the bidding system, the Community Care Access Centres have cautioned that the return to competition for home care services will not necessarily save money nor narrow the gap between the costs of agencies providing identical services. The auditor notes that in some cases the rates paid for shift nursing services by one CCAC could be twice as high as those paid by another CCAC.
While proponents of the bidding system – including former Minister Elinor Caplan – have argued the competitions enhance quality, the auditor says we just don’t have the present oversight to even know if patients are receiving the care the province is paying for – let alone measure quality.
According to the Auditor, three-quarters of the service providers had limited ability to assess whether their staff had delivered the required services in the client’s home in a timely manner. Further, 60 per cent of service providers had inaccurate or unclear definitions of what constituted a missed visit.
More disturbing is the inconsistent data that was made available. At one CCAC a service provider reported that it had rejected about seven per cent of requests for service in that quarter – the auditor’s review of the CCAC data showed that the provider had in fact rejected 39 per cent of requests for its services.
The auditor noted that the number of service complaints was relatively small compared to the number of clients the agencies see. However, his office fails to acknowledge that many care recipients are reluctant to complain about their service less they be taken off care. The auditor notes the CCACs told his staff that some issues brought to case managers by clients or family members were not classified as formal complaints, while others were dealt with as “events.” It’s hard to boast about how few complaints there are when the system doesn’t even have a standardized description of what a complaint is.
The auditor writes that the service discrepancies may be based partially on historic funding patterns. While the auditor likes the idea of a funding formula that reflects real need, it may be difficult to implement when one agency can be charging double that of another agency to provide the same service.
The auditor also notes that lengthy waits for service are also due to a lack of both human and financial resources. With the return of competitive bidding it will only accelerate this problem as professional workers will continue to leave in the face of continued job insecurity.
There is enough in the auditor’s report to warrant a deeper look at the present home care system. Ontario is the only province to rely almost exclusively on contracted service providers.
Its time for the McGuinty government to finally deal with Mike Harris’ failed home care system – a system they too opposed while in opposition.