Home care increases slip downward in 2014-15 budget

Ontario Health Minister Deb Matthews has had a fairly consistent narrative of late – health services should be delivered closer to home, or more specifically, in the home.

It’s been the justification for a lengthy freeze on hospital base budgets – now predictably frozen for the third year. The answer to every hospital cut is ‘don’t worry, it will be delivered in the community.”

If there is one interesting aspect of the 2014 provincial budget it’s this: the amount of money the Wynne government has allocated for home care is beginning to slip.

Last year’s budget promised a six per cent increase for home care. This year it is pegged at five per cent, or $270 million. The three year total for home care is forecast to be $750 million, which suggests a further slide in investment next year and the year after.

Given existing pressures from underfunded hospitals, this will likely mean the stated goal of the province to meet a five-day target for accessing home care is a pipe dream. In the budget documents they admit that only half of the LHINs are achieving that target at present.

The decision to slow the rate of growth in home care spending is also curious given the government decision yesterday to increase the minimum wage for personal support workers in the sector. Is this also to come out of the five per cent?

Further the documents reveal the government intends to relax accountability for private for-profit home care agencies by allowing them to both assess and provide services directly to clients with less complex needs. The government claims this is more flexible care – we would argue it gives the private sector more flexibility to reap bigger profits. This will be a substantial change for the Care Coordinators at the Community Care Access Centres.

The government is at last expanding its mental health investments beyond children and youth. It intends to spend $65 million in new money for improved transitions between youth and adult services, for addictions, prevention, housing supports, and integrated health and social services initiatives. Given how far that will be spread around, don’t look for major change here. The government says it intends to expand that funding by $83 million in time for 2016-17.

Hospitals overall will face a slightly tighter squeeze. While base budgets were frozen for a third year, overall funding increased by about one per cent last year thanks to targeted envelope funding. This year the projection is slightly less at 0.7 per cent. That will likely translate into less money for specific procedures, such as hip and knee replacements.

While there are a number of investments aimed at addressing the social determinants of health, missing is the $80 million that was recommended to address childhood obesity.

No figure is given for sustaining Ontario’s long term care homes, although the municipalities may be picking up more of the cost as the Wynne government intends to exempt not-for-profit nursing homes from property tax.

No mention is given of the controversial decision to have independent health facilities (private clinics) compete with hospitals for the right to deliver existing hospital services.

Given the expanded role of the Ombudsman, the government does reiterate its plan to have a separate “Patient Ombudsman,” which would be specifically focussed on patient complaints only.

We’ve been hearing that the government may have finally had its fill of major new hospital infrastructure projects. The budget notes the 100 major projects built or underway (including 23 new hospitals), but only offers $700 million spread out over 10 years in new money for “critical repairs.” This compares to $29 billion for transportation infrastructure over the same period of time. This may be bad news for communities that have been left out of the recent hospital building orgy.

Much has been made in recent days of the government’s deficit projections. The reality is Finance Minister Charles Sousa reported last year’s deficit was about $400 million ahead of target. The projection is to rise slightly – from $11.3 billion to $12.5 billion this year. Given the track record of this government in over-estimating deficits, we would count on something considerably lower by the time it reaches public accounts in 2015.

The Wynne government is still committed to balance by 2017-2018.

Overall health care spending is anticipated to rise from $48.76 billion in 2013-14 to $50.05 billion in 2014-15, an increase of $1.29 billion, or 2.6 per cent. That’s higher than what was forecast from last year, but it still means considerable restraint ahead.

The biggest increase, aside from home care, will be on the cost of maintaining Ontario’s drug programs, which is expected to cost the province 3.1 per cent more.

More reaction tomorrow!

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