A tale of two physiotherapists: Why professionals oppose competitive bidding in home care

Sharon and Jackie (not their real names) are experienced physiotherapists nearing retirement. Both do exactly the same public home care work within the region covered by the Champlain CCAC.

Sharon works in the Renfrew area. Jackie works within the City of Ottawa.

The two began their community physiotherapy work as municipal employees in 1992 and 1988 respectively.

When the CCACs were formed, the service transferred from the municipalities to the provincially-run centres. While that also meant transferring from an OMERS pension plan to a HOOP plan, the physiotherapists were told they would experience no actuarial loss. This turned out not to be true, and has been the subject of a lengthy court case about to enter its second decade.

When Mike Harris decided that he wanted CCACs to become contracting agencies, not actually deliver health care, he insisted they divest their front line professionals to private agencies who would bid on the work.

At the time, there were more than 40 CCACs in the province.

Jackie’s CCAC decided to contract out her job to Kaymar Rehabilitation, a private for-profit company.

At the time Jackie was allowed to migrate with the terms and conditions of her employment intact, including her OPSEU representation.

Sharon’s CCAC put out an RFP (Request for Proposal) for physiotherapy services, but the bids came in at double the cost of retaining the service in-house. The Renfrew CCAC decided to directly run physiotherapy services and save taxpayers about $2 million a year.

That meant stability for the therapists and other allied health professionals in Renfrew.

In 2004 Jackie’s agency lost the physiotherapy contract through a new bidding process. The work was awarded to two not-for-profit agencies, COTA and VON. Neither had experience with rehab services in Ottawa despite the claims that the CCAC was awarding these contracts based on quality more than price.

Jackie ended up doing the same work, but for a new employer – VON. That meant another break in her pension, from OMERS to HOOP to the VON pension plan. She was unable to bring her collective agreement with her, taking a significant loss in her wages and benefits. When she left Kaymar she was earning $35.76 per hour. Six years later her salary is $35.66 per hour, and like other public sector workers, is facing a government intent on freezing her wages further. The vacation she had built up was lost, returning her to three weeks from five.

When the local VON branch she was working for decided to separate from VON Canada and incorporate as the not-for-profit Carefor agency, Jackie found herself with another break in her pension as she migrated for a fourth time to the new Carefor plan. Given most pension funds are based on your best years with that fund, a break means a considerable loss in final benefits upon retirement.

Sharon is looking forward to her retirement, which is drawing near. Jackie is not, left insecure by the constant changes to her plan. Had Jackie remained in HOOP, her plan would be worth $20,760 per year. Instead, her combined plan is now worth only $14,165.

Had Jackie remained a public employee with the CCAC her agency now works for, she would also be earning much more. Sharon, working directly for the CCAC, earns $39.78 per hour (top of scale). Jackie earns $35.66 (top of scale) with Carefor. Sharon receives 52 cents a kilometre for her travel between home care appointments. Jackie receives 45 cents. Sharon gets two paid breaks on a seven hour day. Jackie gets no paid breaks on a seven and a half hour day. Sharon does not work on weekends. Jackie does, and receives no premium for doing so unless on call. Jackie has no paid education leave to upgrade her skills. Sharon does.

Not surprisingly there is very little turnover among Sharon’s colleagues. She says people mainly leave if their family is relocating. Last year one occupational therapist left. The CCAC did layoff a dietitian, but she was able to bump into another vacant position. This is the most turnover the Renfrew-area office of the Champlain CCAC has had in four years. The CCAC office has 34 allied staff – dietitians, social workers, occupational therapist and physiotherapists. Most are full-time.

For Jackie recruitment is a constant issue at her agency. They have 24 full and part-time allied staff. Seven have left in the last 14 months. Among 14 new staff hired in that period, five have since left. Hours at her agency are frequently erratic as the CCAC tries to balance their budgets towards the end of the year.

While total staffing has remained stable in Renfrew County, where the CCAC is the employer, the same cannot be said for the City of Ottawa and its contract employees. In 2003, before Kaymar lost its contract, they had more than 30 physiotherapists serving the City of Ottawa. When the contract was split between COTA and VON, the number of physiotherapists was reduced to about 10 each. The numbers have shrunk even further. At one point the VON was down to five physiotherapists to cover half the city. There are now seven at Carefor.

In the same period of time, Renfrew County received two additional CCAC physiotherapists, taking their complement up to 12 full-time equivalents to cover a county of 93,000 people.

Every time competitive bidding returns, talk turns to divesting these remaining front line professionals at the CCAC.

Clearly contracting out has led to an unstable work environment, lower wages and benefits, and a decline in service for the Ottawa area. It has affected the ability of these health care professionals to retire with dignity.

Keep in mind that the CCAC refused to divest the Renfrew workers because taxpayers would have paid more for the same services.

Many CCACs refused to apply for a similar exemption to divest, paying a premium to go private and appease the ideology of the day.

The higher cost of sending this work to a private agency does not include the administration of such contracts by the CCAC or cost associated with running the competitions.

At one point Dalton McGuinty was opposed to competitive bidding for home care services.

“If we begin to look at health care as a commodity to be auctioned off to the lowest bidder, we’re looking at a reduction in the quality of services,” he said as Opposition Leader in 2003. “That’s what we’re beginning to experience today in Ontario.”

Opposition to competitive bidding has led to an extended moratorium on the process and contract renewals since 2004.

Many existing agency contracts are now about to expire this summer. There is great anxiety among health care professionals working in the sector as to what happens next.

That includes whether existing CCAC health care providers will be divested.

For Sharon and Jackie, both are deeply concerned about what happens next. For Sharon, she may just decide to retire rather than go through the divestment process. For Jackie, she may not be able to afford to do so.

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