Will $260 million help restore home care clinical services? Maybe

For home care this is significant.

With their feet held to the fire by the NDP, the Wynne government announced last week they were going to invest $260 million in additional funding for home and community care services this year.

It was a significant enough announcement that the press release came from the Premier’s office, not from the Minister of Health.

Depending on how it’s allocated, this could be the single largest increase in home care funding since the Liberals came to power in October 2003.

Given the loose definition of “community,” we wonder how much of that will actually be delivered via the Community Care Access Centres and their contract agencies, and how much will end up at the Community Health Centres, Family Health Teams and other community-based provider organizations.

Unfortunately, they aren’t saying where this money will come from, only that it will be reallocated from elsewhere in the health budget. That could mean this “new” funding will also come with a sharp increase in demand from wherever the cuts are being made.

Part of that money will likely include the $33 million announced for physiotherapy delivered by the CCACs. That reverses a multi-year trend where funding for all home care therapies were being reduced at the same time as hospitals were being encouraged to reduce or axe outpatient rehab services. The end result for too many Ontarians was to pay out-of-pocket or go without.

Between 2007-08 and 2010-11 Ontario had funded almost 100,000 fewer annual “units” of physiotherapy delivered through the CCACs. As well, there were significantly fewer units of speech language pathology, dietetics, and occupational therapy. Social work lost more than $2 million in home care funding over four years, leading to a drop in service units from 81,669 in 2007-08 to 52,371 in 2010-11.

As much as the government grumbled about alternative level of care patients who could be better served at home, visiting nursing units were also dropped over the same four-year period from about 5.7 million units to 5.1 million units province-wide.

So much for the idea that hospital cuts merely represented a reorganization of health care.

The evidence would suggest for all the talk about shifting funding to home care, it didn’t really happen. In 2005-06 home care represented 4.47 per cent of the Ontario provincial health budget. In 2011-12 it represented 4.47 per cent – exactly the same. In between it actually dropped as a share of health funding.

Most of the new funding in home care is being directed to personal support workers, where units of service increased by almost 4 million units from 2007-08 to 2010-11. However, this is not exactly replacing the hospital clinical care Ontarians believed they could now access at home.

Home care has been called the next essential service, yet for all the rhetoric, the provinces have hardly put their money where their mouth is. Across Canada home care makes up just 4 per cent of provincial health budgets – that means Ontario is actually more generous than most. Wealthy Alberta spent only 2.4 per cent of their 2010-11 budget on home care, and resource-rich Saskatchewan slightly better at 3 per cent.

While the “new” or “recycled” money may be welcome, we are concerned that the province is now piloting new schemes in home care that could increase administration and reduce accountability.

We’ll be posting more on this next week.

(Data for this story comes from government sources listed in the new edition of Portraits of Home Care in Canada 2013, published by the Canadian Home Care Association)