Ontario presently provides more than 29 million hours of home care per year. Another 20 million hours are paid for out of pocket or through private insurance.
The NDP are promising another million hours, the Liberals are offering three million.
According to the Ontario Home Care Association, while the hours of care are up, the number of patients served in 2009/10 was about 45,000 fewer than in 2005/06.
When the Liberals increased the cap on how many hours of care an individual could receive, they did not put sufficient resources into the system to deal with the actual draw on services. With more patients discharged in worse condition from hospitals, the “clients” home care agencies and CCACs see are also much more labour-intensive.
Further, as a percentage of overall health care spending, home care has been in a slow but steady decline. In 1999 it made up 5.47 per cent of public health care spending. By 2009/10 it took up 4.13 per cent.
This is at a time when hospitals have been pushed to clear their beds of so-called “alternate level of care” patients, putting more pressure on the CCACs and long term care homes.
It presently cost $1.9 billion to provide Ontarians with public home care visits.
Where will the money from these new commitments come from?
The auditor looked at the government spending projections prior to the beginning of the election and concluded that base home care increases would be two-thirds less than the existing pattern. That means their base assumptions for funding are far less that the status quo. So, would Ontario need to cut home care before it adds the million, or three million hours? This doesn’t make much sense.
This is what the Ontario auditor had to say: “We were advised that a key strategy for containing growth in hospital expenditures is increasing community home care support and long-term care availability to enable more acute or alternative levels of care for patients discharged from hospitals. Because this will increase demand and therefore expenses for both long term care homes and CCACs, which currently already have wait lists, we concluded that the government’s assumption that both programs will be able to significantly reduce their annual expenditure growth rate is optimistic rather than cautious.”
The NDP have stated that they would take on the competitive bidding system, which they assume would free up $25 million by 2013/14 and $100 million by 2015/16. They plan to begin by conducting a review of the present system with the goal of moving towards a more publicly-delivered home care.
The Ontario Home Care Association insists that administration only counts for 10 per cent of budgets, but that calculation leaves out the administrative work conducted by CCAC case managers. While not all of the case managers’ work is administrative, case managers account for 23 per cent of CCAC costs. The association’s calculation is likely to leave out the cost of preparing bids, evaluating bids, severing employees, hiring replacement workers, and other consequences tied to the present bidding process. The Ontario Health Coalition estimates the current system has led to administrative costs at least at the 30 per cent level.
The Tories are much vaguer about their home care projections, likely a result of having a platform with the highest level of spending restraint. According to the Toronto Star, they plan to spend $175 million more on home care. They are also promising 5,000 new long term care beds.