Home care has to be the most tiered health care service in Ontario. Consider that many front line care providers are not on salary, but operating as independent contractors to agencies. The agencies in turn are contracted by the Community Care Access Centres. The Community Care Access Centres sign accountability agreements with the Local Health Integration Networks, which in turn report to the Ministry of Health.
That’s a lot of layers of bureaucracy to facilitate a home care visit.
The Ontario Health Coalition released a new home care report April 4th that suggests about 30 per cent of home care costs are administrative. That may be very conservative.
For the past 15 years the government has been trying to fit a square peg through a round hole as it tries to implement a system of competitive bidding for home care contracts.
The results of these competitions have been what the Toronto Star recently called “politically explosive” as often long-serving not-for-profit agencies lose out to less experienced for-profit companies. When that happens, all the workers who provide both professional and supportive care lose their job and patients lose continuity of care.
In 2008 when the VON and St. Joseph’s Home Care were eliminated from an active competition to provide nursing care in the Hamilton community, the outcry was huge. More than 1500 people came out mid-winter to a rally and effectively forced the government to once again extend a moratorium that had been in place since 2004.
Health Minister Deb Matthews has been coy about the issue – suggesting the government is in no hurry to resurrect competitive bidding. However, Matthews has neither ruled it out, making workers in the sector wonder if the mid-2012 expiry of their home care contracts will mean new competitions after the fall election is out of the way. The process takes about six months from tender to award to contract changeover.
And of course, while the Liberals are in no rush, competitive bidding was the brain child of the Tories, and would likely return competitive bidding even faster under a Hudak government.
While home care has been at the cornerstone of the McGuinty government’s efforts to empty hospitals of alternate level of care patients, the money has not followed. In 1999 home care represented 5.5 per cent of provincial health care spending. In 2010 it had dropped to 4.5 per cent.
According to the Ontario Health Coalition’s “Still Waiting” report from 2004 to 2010 overall funding for CCACs increased from $1.22 billion to $1.76 billion while clients increased from 350,000 to 586,000. In other words, funding went up by 40 per cent while the number of clients increased by 66 per cent.
In 2008 the government raised caps on individual service from 80 to 120 hours of service per month for the first 30 days and from 60 to 90 hours of service per month afterwards.
The raising of the caps, the increase in the number of patients, the lack of funding and the pressure hospitals have been under to empty beds has left many CCACs scrambling.
Reforms to competitive bidding were supposed to address problems regarding continuity of care, assessing quality, monitoring performance and addressing client and input and complaints. However, as the recent auditor’s report indicates, these are all still continuing problems in the sector.
To read the complete Ontario Health Coalition report, go to: http://www.web.net/~ohc/homecare2011finalreport.pdf
Watch OPSEU’s music video on home care at: