Jumping into the fire

The last few days appear to suggest the brave new world of health reform is not unfolding as it theoretically should.

The news is all around us: another violent death in a nursing home; another frail senior discharged early from hospital without support; another community upset about losing a key hospital service; and a fresh report to suggest we are losing the battle to tackle the social determinants of health.

To make matters worse, a leaked report over the weekend from the Tories suggests that the next election may revolve around further assaulting the standard of living for working people by significantly undermining their unions. Does anybody believe a declining standard of living is going to improve anything, let alone population health in Ontario?

If you were Sandy Bullock lost in space, would you really want to struggle that hard to come back to earth?

Given how much stock the government has placed on moving patients out of hospital and into community, the entire agenda may implode once Ontarians discover for themselves how threadbare is the alternative.

That includes 85-year-old Joanne Stokman, who was sent home from the Rouge Valley Health System sooner than usual — just three days after hip surgery (the average is 4.4 days).

We’ve written on numerous occasions how the Scarborough and Rouge Valley hospitals are looking to shave a combined $28 million from their budgets due to an ongoing base-funding freeze. To make matters worse, apparently serving a high-needs community and performing a large number of surgeries actually works against you in the hospital funding formula sweepstakes.

Joanne Stokman got pushed off the burning platform that Health Minister Deb Matthews has created in her zeal to shift health care to all things community.

Problem was, when Stokman leaped there was no one there to catch her. According to the Toronto Sun, nobody came to see her for 14 days after discharge.

At an absolute minimum, a freeze on base hospital funding would amount to roughly a $600 million impact when inflation, population growth and the impact of aging are taken into consideration. How much ended up at the Community Care Access Centres? The answer: $185 million. If you add in community care, that number expands to $260 million, or less than half of what the government is saving by putting the freeze on hospitals.

How much of an increase are long term care homes receiving? The answer is 2 per cent. Part of that 2 per cent is intended to create a few hundred new short term beds in these homes also for people kicked out of hospital early.

The City of Toronto used to top up funding to its 10 nursing homes, recognizing during the Harris era that base provincial funding was not enough.

It is therefore tragic to see one of the City homes in the spotlight this weekend after an 81-year-old resident was charged with second-degree murder following a suspicious death of another resident.

As the Toronto Star makes clear, the situation has not been great for some time. One inspection noted that two-thirds of staff had not been trained on residents’ rights and mandatory reporting. Half of staff had not received training on mental health issues despite the facility having a much higher rate of “case complexity” among City-run homes.

In all the Star notes the 456-bed home had 31 ministry inspection logs in just 29 months.

“This is what keeps people up at night,” Donna Rubin told the Star. The Chief Executive Officer of the Ontario Association of Non-Profit Homes and Services for Seniors went on to say they can’t guarantee safety. “We don’t have enough people on the floor. They are not adequately trained.”

As we reported last week, beyond such anecdotes, there is also evidence staffing has not kept pace in Ontario with rising acuity levels among nursing home residents.

Windsor residents also had a lot to say this weekend after learning that they may soon have to travel about 180 kms to London to seek thoracic (chest) surgery. This after the Windsor Regional Hospital was told it would lose all cancer funding if thoracic surgery were not transferred out of this city of 216,000.

The province is arguing that the volumes done in London somehow makes these surgeries safer, although no evidence has been released by Cancer Care Ontario to suggest there is any difference in outcomes between the two cities.

NDP MPP Taras Natyshak has put up an on-line petition to save cancer care in Windsor.

When the Health Minister spoke at last week’s Ontario Hospital Association HealthAchieve, among the many accomplishments she claimed was a reduction in poverty.

Yet today’s Toronto Star reports that more than 158,000 Ontario households were waiting for an affordable place to live as of last December. That’s about 3 per cent of all households in the province – the highest recorded number since Ontario’s Non-Profit Housing Association started keeping track.

Of all the social determinants of health, safe and affordable housing is key. Not only are we not building sufficient affordable housing, but existing stock is badly in need of maintenance and repair. Just one such provider — Toronto Community Housing – says it has a $862 million repair backlog.

While serious social challenges are facing the Wynne government, they are instead toying with the idea of importing UK and American-style policies that will turn financing of social endeavors over to investors looking to make a buck off on Ontario’s most marginalized citizens (more later this week).

It’s clear that health care reform does not go hand-in-hand with austerity. Two weeks ago Dr. Danielle Martin told a Conference Board forum “enough already” with the burning platform. Perhaps not understanding what she was driving at, another speaker suggested “there was enough wood under there already.”

The problem is, we are all being asked to jump into the fire.

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