Category Archives: CCAC

What took so long for community funding to arrive?

Community health care received the biggest percentage increase from this spring’s provincial budget, signalling the government’s intention to transition more of the health system into home care and other community supports.

At four per cent clearly that transition is not going to be at an overwhelming speed, the money barely enough to cover inflation, population growth and the impact of an aging population. However, compared to the base funding freeze for hospitals, this looked like one sector that at least wouldn’t be scaling back health services this year.

For much of 2012 many home care watchers were wondering if and when the money would actually arrive in the sector. Finally in recent weeks there has been a series of announcements around new funding to Community Care Access Centres (CCAC) and other community-based services agencies.

The funding will extend beyond traditional home care. The Central East LHIN, for example, has allocated $9 million in funding to the CCAC, but there is more than $2.6 million more going to other recipients, including new and expanding adult day programs in Whitby and Peterborough, increased hours for the Nurse Practitioner clinic at the Port Hope Community Centre, expanding advanced addiction and concurrent disorders treatment capacity in Scarborough and Durham, more services for individuals living with acquired brain injury and increases in assisted living for a number of communities. The November 14th CE LHIN press release noted that $1.08 million was still not earmarked.

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CCACs could play expanded role as direct home care providers

Doris Grinspun, the executive director of the Registered Nurses Association of Ontario (RNAO) has been a tireless defender of public not-for-profit health care. We’ve seen her speak truth to power at numerous conferences and public events. When she advocates on behalf of the RNAO, she speaks plainly and passionately.

Last month the RNAO released its submission to the government on Ontario’s seniors care strategy.

The document is full of good recommendations, from strong staffing standards in long-term care homes to a broadening of the policy lens to include government’s impact on the social determinants of health.

The biggest surprise, coming out during the same month as the Hudak health care platform, is the RNAO’s recommendation that the Community Care Access Centres be scrapped and the work be redistributed to the Local Health Integration Networks and to primary care providers, such as family health teams, community health centres and nurse practitioner-led clinics.

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VON Hamilton nurses subject to demeaning cyber-tracking

Nurses at VON Hamilton may be wary of construction detours en route to seeing their home care patients.

The VON branch is taking employee tracking to an extreme by issuing Blackberry devices that will not only record arrival time at each “client’s” home, but also whether they have “deviated from route” on the way there.

The tracking was outlined a September 6 memo from Germaine Lee and Mimi Mitchell, managers at VON Hamilton.

Clearly management at VON Hamilton has too little to do if they intend to spend their days figuring out whether their nurses went directly to the home of the next client or deviated a few blocks to pick up a Tim’s.

It is also shockingly demeaning to professional workers to engage in this level of monitoring when a missed or late appointment is likely to result in a call from the waiting patient anyway.

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Stories we couldn’t let pass by this week

CCACs hire 144 direct care nurses

This month the government announced 900 new nursing positions to come from their 2007 commitment to 9,000 new nurses for the health system. Among them are 144 nurses who will go into the schools to support early identification and intervention of students with potential mental health and/or addictions issues. The nurses will assess and develop plans of care, provide direct service for mild cases, and offer support and referral for more complex issues. What’s particularly interesting about this initiative is these nurses will be working directly for the Community Care Access Centres, the first new hires to provide direct care since Bob Rae was in the Premier’s seat. When Mike Harris changed the NDP’s multi-service agencies into the CCACs, he insisted that a strict purchaser-provider split exist, hoping to divest all direct care workers to private agencies. He never entirely succeeded – OPSEU still represents CCAC home care therapists that were supposed to be divested by 1998. The fact that the government has placed these nurses into the employ of the CCAC is a hopeful sign that the terrible Harris-era competitive bidding process may quietly be coming to an end. While Deb Matthews publicly said competitive bidding would return, OPSEU members are telling us the agency contracts are all being extended again.

Merging surgical departments in Windsor

A zero base budget for hospitals is forcing many administrators to look at novel ways to make ends meet. In Windsor much has been made about Finance Minister Dwight Duncan’s proposal for a very expensive mega-hospital, however, the two hospitals are looking at integration options that might save money in the meantime. Windsor Hotel Dieu is pushing for greater coordination of surgical departments with the Windsor Regional Hospital. Facing a $700,000 operating room budget deficit, Dieu is hoping costs could be saved by having the two hospitals move into even greater specialization than currently exists. Dieu presently specializes in trauma and neurosurgery while WRH does most of the pediatric surgeries. WRH CEO David Musyj told the Windsor Star he was cautious — concerned that Hotel Dieu’s financial problems could put more pressure on his 11 operating rooms.

Harper attacks Council of Canadians

Our friends at the Council of Canadians are under attack by the Harper government for encouraging Canadians to overturn elections of seven Tories elected in ridings involved in the so-called robocall scandal. According to the Ottawa Citizen, the Federal Tories hope to overturn lawsuits that seek new elections in the ridings. The Tories are basing their bid to throw out the lawsuits on an obscure and ancient legal prohibition against “champerty and maintenance,” which the Citizen describes as “meddling in another party’s lawsuit to share in the proceeds.” While the Council of Canadians would not stand to gain anything monetarily from the actions, the Tories highlight a Council fundraising campaign that notes the challenge among its work. Of course the Tories have no problems with right-wing organizations, many with American funding, helping to litigate against such left-wing institutions as Medicare. That includes the Canadian Constitution Foundation, an extreme right-wing group based in Alberta that supported Lindsay McCreith and Shona Holmes in their 2007 case intended to open up Ontario to two-tier private health insurance. While the CCF doesn’t say where their money comes from, they do specifically note on their website that they have charitable status with the U.S. Internal Revenue Service. Like the Council of Canadians, the CCF lists its McCreith/Holmes case as among the worthy activities it undertakes to solicit donations.

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.

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Drummond Report: Health care sectors get funding restraint… and a pony

Don Drummond wants to provide every health care provider with their own pony while the system gets squeezed another notch tighter.

In his report released this week, the Commissioner on Public Sector reform wants to implement everything from increased salaries for the CEOs of the Local Health Integration Networks to triple the per capita spending on public health.

All this is to take place while restraining health care spending increases to 2.5 per cent per year – about half the funding increase from 2011.

Where the savings come from with all this new investment is not clear, nor is there an explanation on how so much can be done with so little. In fact, there is very little costing associated with any of these recommendations.

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LHINs – Funding in a time of scarcity

This spring’s provincial budget set aside a three per cent base funding increase for community-based health care agencies this year. That doesn’t mean Community Care Access Centres, Canadian Mental Health Association branches or other local agencies will necessarily receive that amount.

The dilemma for the Local Health Integration Networks is whether to pass on an across–the-board increase that amounts to less than this spring’s Consumer Price Index, or whether to split that modest increase to address specific problems within the regional health care system? Do you make the situation worse for some agencies by slashing their funding increase to improve the situation for high-priority agencies faced with significant challenges? Either way, you know somebody is going to be unhappy. Worst still, does the absence of adequate funding for some agencies show up in new unforeseen challenges for next year?

The Central East LHIN passed a motion today that effectively cleaved the across-the-board funding increase in half – to 1.5 per cent – while using the remaining funds to address some serious problems within the LHIN. For those receiving only the 1.5 per cent, they will be in good company with the hospitals, most of whom will receive a similar base increase for a second year in a row.

 What is important to stress is that these are base increases, not total increases.

As we have seen with the hospitals, while the base was 1.5 per cent, many hospitals increased their bottom line by more than 4 per cent last year thanks to a variety of budget envelopes and increases in own-source revenues. For some agencies, particularly the very small ones, 1.5 per cent could turn out to be the total they do receive. James Meloche, a Senior Director with the CE LHIN, said 1.5 per cent could amount to as little as $900 for some agencies.

The 1.5 per cent the LHIN is reallocating is not a huge amount – about $5 million to support a population of 1.4 million, or about 11 per cent of Ontario’s population.  That’s about $3.50 per resident. This is on a provincial health budget of $47 billion.

While Don Drummond hammers away at unsustainable costs, there are no huge funding increases here at the health care coalface.

Clearly the region has a capacity problem, particularly when it comes to placing seniors into care following a hospital stay.

The LHIN has decided that it will address the problem by targeting the problem further upstream. By providing improved supports in the home, the LHIN hopes to avoid the arrival of seniors in the region’s already crowded emergency departments. Keeping people healthy is far more likely to be a winning strategy.

That does not necessarily mean more money for the CCAC – in fact, even with an allocation of almost half the available money, the CCAC will receive slightly less than the three per cent.

The LHIN is betting that more assisted living – including home making and falls prevention, among other services – will help keep seniors healthier in their homes and avoid hospital admissions.

The Oshawa/Whitby area will also be targeted, particularly for increased support for mental health and addictions. With a struggling economy, the communities have been hard hit by the recession, a situation that is putting pressure on health care providers.

“Clearly we have an issue at Lakeridge Health,” said Meloche. “People live in the park and they come to the emergency department for care.”

Fortunately one of the few mental health agencies in Ontario that will receive patients with concurrent addictions problems is already in the Oshawa community.  While several years ago Pinewood/Destiny Manor faced closure from a Ministry that wanted the hospital to cut unfunded mental health services, the service is now considered a major asset for the LHIN.

The LHIN is also trying to take some of the pressure off the Northeast part of its region by providing about $259,000 to establish a rural-based palliative care team.

While these are the priorities of the Central East LHIN, it does not necessarily mean that other LHINs will treat the funding in this manner.

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The Central East LHIN used their “Urgent Priority Funding” to increase the volume of MRIs available in the region.  Senior Director Paul Barker pointed out that while the government was generously funding new MRI machines in the region, the actual funding for scans had gone down. The LHIN is tapping into this fund to provide $285,327 to buy 1,096 more MRI hours. Most hospitals can conduct about 1.5 scans per hour. The average wait for an MRI scan in the LHIN was 77 days as of July. One board member asked how it was Ontario hospitals could perform MRI scans for $260 an hour when they were charging $1600 for the same service in the United States. Barker pointed out that it may have something to do with the free market and profit-taking.

 As part of its planned to establish an umbrella organization to coordinate specialized geriatric services, the LHIN named the Northumberland Hills Hospital the “host agency.” A small secretariat will be set up at the hospital to work on a strategy to better deliver services to frail seniors. The immediate task will be to hire a project manager, recruit staff, establish office space and work on governance issues. The LHIN had found service providers, seniors and their families were largely unaware of what services were available in the LHIN. 2,100 seniors account for a third of all acute spending on seniors in the LHIN.  By focusing on the needs of this population, it could have a substantial impact on the overall use of acute care services in the LHIN.