Category Archives: Home Care

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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CCACs not given sufficient resources to deal with “home first” initiative

The government speaks regularly about moving services out of hospitals and into community-based care, including nursing homes and home care.

They tell us that it is not only more cost-effective, but it is preferred by patients.

So what is the deal with holding the line on CCACs and nursing home beds at a time when the hospitals are being placed under extreme pressure to move alternate level of care patients into the community?

The latest conflict is in Windsor, where the LHIN has refused to give the Community Care Access Centre a waiver to run a $5.2 million deficit.

The CCAC is arguing demand is on the rise and patients will be stranded in hospital if they are unable to provide home care services. Just yesterday Windsor Regional Hospital CEO David Musyj was urging patients to go elsewhere in the anticipated post-Christmas rise in demand for ER services.

No home care. No hospital care. People in the Windsor area must be truly wondering about the direction of their health care.

The CCAC says the overall increase in home care patients is rising by 1,000 to 1,500 per year in Erie St. Clair, and coming out of hospital sooner, these patients are more costly to serve. The cost of the CCACs end-of-life program is rising by 11 per cent per year.

The CCAC is also facing more demand because of delay in the building of a planned 256 bed long-term care home at St. Clair College. They say that delay is costing them $3 million annually.

The LHIN is willing to help out with a one-time grant of $1.5 million while they “study” the needs of the CCAC. In an unusually frank retort, CCAC Executive Director Betty Kutcha told the Windsor Star that “in my view, they’ve got a $1.5 million solution, so they’re trying to fit our problem into that.”

We are hearing that the Home First program – an initiative where hospitals are supposed to discharge patients home to wait for long-term care placement – is increasing overall community referrals to the CCACs by 10 per cent or more. This is a significant strain on their budgets.

Even the Auditor General of Ontario was skeptical in his summer report of the government’s plans to reduce the rate of growth in hospital spending based on service from home care and long-term care where the level of restraint is expected to be even more severe.

When the Health Restructuring Commission of the late 1990s made its recommendations around the transfer of mental health services to community-based agencies, they were adamant that no beds should close until community-based resources were established. The government cut the beds, didn’t provide anywhere near adequate service in the community, and left us with a system that has been the subject of one report after another calling for better.

Are we to repeat the experience as the government pushes hospitals to discharge patients before adequate community resources are put in place?

Seems we never learn.

Is McGuinty quietly adopting the Walker report?

August 31st the Ontario Ministry of Health did a curious thing. They posted on their website a report by Dr. David Walker, who had been appointed ALC lead back in January. There was no press release, no press conference, no op/eds were written supporting Walker’s 32 recommendations. Walker had submitted his report at the end of June, and for two months the government mulled it over before deciding to make it public on the eve of an election. During that election there was virtually no talk of Walker’s report.

ALC is the term for alternate level of care patients — those who have completed their acute care treatment in hospital but are not stable enough to return home.

Normally this kind of treatment of a report indicates a “thanks, but no thanks” attitude by government. However, at a meeting with public service reform commissioner Don Drummond, the Ontario Health Coalition was told that the government has actually accepted the recommendations of Walker.

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Competition for home care contracts blocks information sharing and coordination — OHC

The Executive Director of the Ontario Home Care Association recently wrote to the Toronto Star making claims about home care agencies being more accountable and transparent. Sue VanderBent also says home care agencies have better client service indicators than ever before. Of course, those who are having difficulty accessing home care in Ontario may beg to differ on the question of access and quality. Natalie Mehra, Executive Director of the Ontario Health Coalition replies to VanderBent below:

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Will auditor’s report prompt Libs and PCs to reconsider health funding?

The Liberals and Tories may want to reconsider their health care funding election pledges following last month’s auditor’s report.

Trying to neutralize the health care issue in the upcoming fall election, PC leader Tim Hudak committed to an increase of $6 billion in new health care spending over the next four years. That works out to be about $1 billion less than the Liberal plan to reduce health care spending increases to 3.6 per cent per year.

At the end of June Ontario Auditor General James McCarter questioned the McGuinty government’s projections of health care costs over the next three years.

“Our view is that, given the health demands of a growing and aging population and an average growth rate in health expenses of 7.1 per cent per year over the past eight years, assuming that health-care costs will rise much more slowly in the next three years cannot be considered cautious.”

Looking at cost assumptions by sector, only the scenario for drugs looked reasonable due to “more definitive plans to contain drug program costs,” including expanded use of generic drugs and a cap on generic drug pricing.

Much of the government’s assumptions rely on zero increases in compensation costs to both unionized workers and doctors.

The OMA agreement is presently in its last year. The auditor writes: “That there will be no increase for health care professionals when the current OMA agreement comes up for renewal in April 2012 is clearly an aggressive rather than a cautious assumption.”

Expense estimates for hospitals assume savings of $1 billion between 2011/12 and 2013/14.

The auditor writes: “The government has indicated that it will be up to hospitals to operate within their funding allocation regardless of how they manage the savings and compensation pressures they face. Therefore, if hospitals do not find $1 billion in savings and do not succeed in freezing compensation, they will likely run deficits or may have little alternative but to cut services.”

While the auditor acknowledges that funding of services provided Community Care Access Centers are far more at the discretion of government, the three year forecast calls for increases of only 2.3 per cent – about a third of the present growth rate of 7.2 per cent per year.

Similarly, it plans to reduce funding increases to long term care from 8.6 per cent per year to 4.2 per cent per year.

The auditor noted the obvious: given home care and long term care are integral to moving alternate level of care patients out of the hospitals, it is hard to see how the hospitals can save money through these transfers if the recipient sectors are being starved of cash.

As damning as the auditor’s pre-election review is towards the Liberal cost projections, consider the fact that the Tories plan to spend even less. To date, the NDP has not released any specific financial commitment towards health care increases.

Inheriting a surprise deficit from the Tories in 2004, the McGuinty government introduced the Fiscal Transparency and Accountability Act requiring the auditor to review and report on the reasonableness of the government’s pre-election report on the province’s finances.

While the past increases may appear daunting, keep in mind that these increases are not inflation adjusted and do not take into consideration levels of economic growth. While these increases in health care spending were taking place, the government managed to reduce its inherited $5.6 billion deficit and balance its budget by 2005-06. It was the global recession of 2008-09 that plunged the government back into deficit, not excessive health care costs.

NDP platform takes on dysfunctional home care system

Ontario NDP leader Andrea Horwath recently told the media she would not be revealing the NDP platform all at once, but the party web site does already contain a comprehensive platform.

The platform includes four major headings –  Making Life Affordable; Creating and Protecting Jobs; Building Healthcare That Works For You; and Living Within Our Means.

The NDP is the only party to commit to taking on the dysfunctional home care system which the most conservative estimates suggest 30 per cent of costs are tied up with administration surrounding the competitive bidding. The NDP would conduct a review of home care with the goal of bringing back a publicly-owned and accountable system. They would also target funding to increase the supply of home care by a million hours within four years.

The NDP see fixing home care as part of unlocking the puzzle of patients stuck in hospital waiting for community-based care. They also plan to add long term care (LTC) beds to eliminate the 2,650 Ontarians presently on the wait list. A recent OHA survey did suggest there were alternate level of care patients waiting for home care, although the majority – 61 per cent – were waiting for LTC. Patients in ALC beds were also waiting for rehab, complex continuing care, palliative care, convalescent care, assisted living/supportive housing as well as placement in mental health care.

The NDP would also add 50 round-the-clock health care clinics to alleviate emergency wait times. The goal would be to increase alternative options to cut hospital emergency department wait times in half.

The NDP commits to bringing more health services back under public OHIP coverage, including the elimination of ambulance fees.

The platform includes a hard cap on CEO salaries, limiting compensation to twice the Premier’s salary. They make the point that it would still compensate CEOs at seven times the level of a nurse. The NDP would also crack down on the use of outside consultants.

An NDP government would also forgive student debt to new doctors willing to locate in underserved areas with the goal of adding 200 doctors over four years to these communities.

The party would make drug costs a priority in any negotiations with the Federal government around a new health accord.

The NDP would open up hospitals to the scrutiny of the ombudsman – something Andre Marin has been asking for in his annual reports.

Like the Tories the NDP would scrap the Local Health Integration Networks (LHINs), however, unlike the Tories, they pledge to replace them with some undetermined form of local decision-making.

No platform would be complete without a promise around prevention, and the NDP do that with a pledge to make mandatory physical education in post-secondary schools, ban junk food advertising to children and force large chain restaurants to label calorie counts.

Still waiting – Ontario Health Coalition releases home care report

Home care has to be the most tiered health care service in Ontario. Consider that many front line care providers are not on salary, but operating as independent contractors to agencies. The agencies in turn are contracted by the Community Care Access Centres. The Community Care Access Centres sign accountability agreements with the Local Health Integration Networks, which in turn report to the Ministry of Health.

That’s a lot of layers of bureaucracy to facilitate a home care visit.

The Ontario Health Coalition released a new home care report April 4th that suggests about 30 per cent of home care costs are administrative. That may be very conservative.

For the past 15 years the government has been trying to fit a square peg through a round hole as it tries to implement a system of competitive bidding for home care contracts.

The results of these competitions have been what the Toronto Star recently called “politically explosive” as often long-serving not-for-profit agencies lose out to less experienced for-profit companies. When that happens, all the workers who provide both professional and supportive care lose their job and patients lose continuity of care.

In 2008 when the VON and St. Joseph’s Home Care were eliminated from an active competition to provide nursing care in the Hamilton community, the outcry was huge. More than 1500 people came out mid-winter to a rally and effectively forced the government to once again extend a moratorium that had been in place since 2004.

Health Minister Deb Matthews has been coy about the issue – suggesting the government is in no hurry to resurrect competitive bidding. However, Matthews has neither ruled it out, making workers in the sector wonder if the mid-2012 expiry of their home care contracts will mean new competitions after the fall election is out of the way. The process takes about six months from tender to award to contract changeover.

And of course, while the Liberals are in no rush, competitive bidding was the brain child of the Tories, and would likely return competitive bidding even faster under a Hudak government.

While home care has been at the cornerstone of the McGuinty government’s efforts to empty hospitals of alternate level of care patients, the money has not followed. In 1999 home care represented 5.5 per cent of provincial health care spending. In 2010 it had dropped to 4.5 per cent.

According to the Ontario Health Coalition’s “Still Waiting” report from 2004 to 2010 overall funding for CCACs increased from $1.22 billion to $1.76 billion while clients increased from 350,000 to 586,000. In other words, funding went up by 40 per cent while the number of clients increased by 66 per cent.

In 2008 the government raised caps on individual service from 80 to 120 hours of service per month for the first 30 days and from 60 to 90 hours of service per month afterwards.

The raising of the caps, the increase in the number of patients, the lack of funding and the pressure hospitals have been under to empty beds has left many CCACs scrambling.

Reforms to competitive bidding were supposed to address problems regarding continuity of care, assessing quality, monitoring performance and addressing client and input and complaints. However, as the recent auditor’s report indicates, these are all still continuing problems in the sector.

To read the complete Ontario Health Coalition report, go to:

Watch OPSEU’s music video on home care at: