Category Archives: Long Term Care

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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Retirement homes in conflict of interest over abuse line — ACE

Have a complaint about abuse at a retirement home? The telephone line you are required to call is operated by the trade association run by the retirement homes – a conflict of interest according to the Advocacy Centre for the Elderly (ACE).

This spring the Ontario government introduced a new Retirement Homes Act, promising to immediately enact provisions to protect seniors living in these homes from abuse.

While the Retirement Homes Regulatory Authority (RHRA) is being set up as part of that Act, the public is being advised to call the Complaints Response and Information Service line (CRIS).

The CRIS line is operated by the Ontario Retirement Community Association (ORCA), the private sector trade association for retirement home operators. That means if you have a complaint about a retirement home, you have to take it back to the advocates for that home. 

ACE is concerned that CRIS will continue to operate the line after this initial set up period, triaging complaints and deciding what gets forwarded on to the independent authority responsible for licensing and inspecting retirement homes.

“ACE has raised this concern with the Office of the Minister Responsible for Seniors given that what is considered abuse and neglect may be different from the perspective of the operators of the CRIS line, the tenants (residents) of the homes, the home operators, and the Authority,” writes Judith Wahl, executive director of ACE in the centre latest newsletter.

ACE is also asking questions about whether complaints to the CRIS line operators will be required to be kept confidential from ORCA – the operator’s employer.

ACE is calling for an independent call line to be maintained directly by the regulator authority, and not by the trade association.

Retirement homes have become more populated with seniors with higher levels of acuity in the absence of available spaces in Ontario’s regulated nursing home sector.

Retirement homes are also being used by hospitals to off-load “alternate level of care” patients who are unable to go home on a short-term basis. The government says they are protecting these patients by applying the Long Term Care Act to these specific beds.

Long term care: We told you so

Earlier this year the Ontario Health Coalition along with several community and labour representatives (including OPSEU) met with senior officials at Ontario’s long term care performance and compliance branch.

We asked a number of questions, most of which they could not answer at the short meeting. Instead they suggested that if we write down our questions, they would send us the answers.

We did, and got back no specific answers, but instead broad links to websites that have hundreds, if not thousands, of pages. The suggestion was the information was out there, we just had to dig for it — the proverbial needle in a haystack.

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Bonnie Brae bed transfer poses some unsettling questions

How many times have we heard the government say it wants to deliver the right care at the right place at the right time?

That mantra may be tested if media reports are correct and the private owner of a Tavistock long-term care home gets his wish to move all 80 beds to London.

There’s much wrong with this proposal, which may explain the official silence around it.

While rumours about the transfer have circulated for months, there has been no open consultation to date by the owners or the Southwest LHIN. Residents and staff of the Centre instead discovered from the media that an application had been made directly to the Ministry of Health.

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Former senior bureaucrat Gail Paech resurfaces at OLTCA

Inside Queen’s Park reports that Gail Paech has been named interim CEO of the Ontario Long Term Care Association.

Paech is well-known in Queen’s Park circles.

She was at the center of controversy in 2009 when it was learned the McGuinty government was hiding the salaries of senior bureaucrats in hospital budgets.

The former CEO of Toronto East General Hospital, Paech was serving as associate deputy minister of economic development and trade but drawing her $291,997 salary from the University Health Network. The recommended maximum for an ADM was $188,950 at the time.

Paech was also Health Results Team Lead for System Integration. She developed the strategic policy framework to support the government’s decision to create the Local Health Integration Networks.

During the e-Health scandal Paech was described by the Toronto Star as being “influential in the program.” In fact, while Sara Kramer took the fall, Paech was in fact the program lead for e-Health. At the time she told the Star it was “not my practice” to award any untendered contracts.

The Ontario Long Term Care Association claims to represent the “full mix of long term care providers”, although it is considered by many to be the primary organizational voice of for-profit nursing homes. It claims to have 430 institutional members. This organization is separate from the Ontario Association for Non-Profit Homes and Services for Seniors.

There is no indication of what Paech’s salary will be.

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.

Can Ontarian’s afford more PC long-term care?

The Progressive Conservatives (PC) under Tim Hudak say they will add an additional 5,000 long-term care beds on top of the 35,000 that are already coming on stream. There is no reason to suggest that Hudak will handle this any different than his predecessor Premier Mike Harris did.

Historically, the relationship between the Conservatives and the long-term care corporations has been very tight.

In 1998, when the government announced a $1 billion would be spent to create 20,000 new long-term care beds in Ontario, the PC’s received large campaign contributions from the top three private for-profit long term care corporations operating in Ontario: Extendicare, Liesureworld, and Central Park Lodges Real Estate Income Trust (CPL REIT)

In 2001 when the tenders were announced, two thirds of the new beds were awarded to for-profit operators. Extendicare, Leisureworld, and CPL REIT received 39.5 per cent of the contracts.

Upon the completion of construction, all the sites received the provincial per diem funding for all beds in operation just like the other facility operators but also continue to receive an additional subsidy of up to $10.35 per bed per day, payable for the next 20 years to offset the cost of borrowing and construction. That is $75,550.00 per bed over 20 years.

This was an unprecedented subsidy of the construction costs for the private sector. After 20 years the facility operators will own the new building with no further obligation to the taxpayers.

In 2001 the private for-profit nursing homes began to operate the majority of LTC home beds in Ontario.

In 2003, Chartwell Real Estate Income Trust (REIT) was formed by consolidating three other private long-term care home operations and according to its trust document was established for the purpose of investing in a portfolio of income-producing seniors facilities. It has grown into one of the largest private long-term care providers in Ontario.

According to information obtained by the Ontario Health Coalition in 2008 through a Freedom of Information request, the lowest level of care is provided in the for-profit nursing homes compared to the not-for profit and municipal facilities.

The latest available data shows Ontario pays 36 per cent more in accommodation rates for long-term care than other provinces.

Most of the large private for-profit operators are structured as a Real Estate Income Trust (REIT) so they don’t pay any corporate taxes.

There is a critical need for long term care beds in Ontario. To get the most efficiency for public funding,  Ontario needs to invest in not-for profit and public long term care beds.

Good discharge laws badly practiced for long term care

The laws governing hospital discharge and admission into long term care (LTC) homes are good but they are badly practiced by hospitals, says Judith Wahl, the Executive Director and Senior Lawyer at the Advocacy Centre for the Elderly (ACE).

Speaking in Toronto June 20th at the High-Level Briefing and Summit on Retirement Homes and Alternate Level of Care (ALC), Wahl was critical of practices that violated existing legislation, calling them unethical.

Some hospital discharge policies include statements that if a person refuses to pick from their short list of nursing homes they must take the first available bed that becomes available or face punitive fees.

An elderly patient was threatened with $1,800-a-day fees from a Toronto area hospital, and a Windsor hospital threatened to charge $600 a day if a patient refused to take the first open bed in a nursing home.

Wahl says it is her opinion that this is illegal.

Hospitals are permitted to charge $53 a day. That rate is also subject to a rate reduction under the Health Insurance Act.

The Long Term Act, passed into legislation in 2010, now makes Community Care Access Centers directly responsible for placement of individuals into long term care, not the hospital.

The CCAC must determine eligibility, assist with the application, and confirms requirements for choice of LTC homes for that person.

The legislation also states that patients can choose up to five homes and is not required to go into a nursing home unless he or she consents. Consent must be informed and voluntary, with fair representation.

Wahl says the Public Hospitals Act (PHA) and Health Insurance Act (HIA) further ensure that on discharge, patients cannot be abandoned even if they have completed their acute care treatment.

For patients and their families that need long term care they must to be aware of their rights on discharge from hospitals.

The Long Term Care Homes Act ensures that patients have the right to choose his or her own care.

PC Platform: Tim Hudak wants you to compete for the job you have

Tim Hudak is no longer the mystery man. The question is, now that his Ontario Progressive Conservative (PC) platform is out there, will it matter?

Hudak has made it clear that he intends to make public sector workers a target, including workers in health care.

“We will introduce initiatives requiring public sector unions to compete for government contracts, where appropriate,” the Tory Changebook states. “If another organization – whether a non-profit group or private business – can provide better value for money, taxpayers deserve to benefit.”

The platform goes on to suggest support services “like food preparation or laundry” in our “public institutions” are a prime example where he expects these competitions to take place.

If you are spared the competition, you may not have your next contract fairly arbitrated. Hudak plans to challenge the independence of the arbitrators, claiming recent awards have been “excessive.”

“We will require arbitrators to respect the ability of taxpayers to pay and take into account local circumstances,” the document states.

Changebook claims the Tories will “bring public sector paycheques in line with private sector standards.”

Specific to health care, Changebook makes the same promise as the McGuinty Liberals when it comes to funding – reduce increases to three per cent per year.

Hudak promises a review of all agencies and commissions, but would axe the LHINs before that even takes place. He would not replace the LHINs, which raises questions about how health care planning, local funding, and community engagement will take place. He says he will redirect the $70 million per year from closing the LHINs into front line care. At present Ontario spends $47 billion on public health care.

The Tories say they will add 5,000 new long term care beds and increase investments in home care to “give families more control over services.” That includes the ability to stay with the provider they have now, or pick a new government-funded home care provider who better meets their individual needs. Given the Tories have supported competitive bidding in home care, it is unclear whether an individual will be able to maintain their provider after they have lost the CCAC contract. While the Tories promise to increase investments in home care, they also promise to find savings at the CCACs.

Hudak says he will clamp down on fraud, but the only specific promise is to demand that people using the old red and white health cards also present another form of government-issued identification, such as a driver’s license or passport.

Unlike the Federal NDP, which promised more doctors and nurses, the Tories only claim to add to the number of doctors by increasing residency placements for medical students from Ontario who have pursued their education outside Canada. They call upon doctors, nurses, nurse practitioners, and physician assistants to work collaboratively, particularly in underserviced areas. There is no mention of the other health professions integral to the public health system.

Like the McGuinty Liberals, the Tories vow to be as obsessive about measuring health outcomes and “introducing a rigorous system of patient satisfaction.” Do we read that as even more patient satisfaction forms to fill out? And how does this square with the promise to reduce bureaucracy?

The Tories say they will make it law that the province cannot raise taxes without a clear mandate. Unfortunately, it is silent on needing the same to cut taxes, particularly for corporations.

They also promise to expand the scope of Freedom of Information, but it is not clear how.

The Tories have already come under fire for their spending commitments and tax cuts. The normally conservative Ottawa Citizen called it the “common nonsense revolution,” comparing Hudak’s plans to reckless debt run up by U.S. President George Bush. “Unlike Bush,” writes Citizen editorial board member Ken Gray, “Premier Dalton McGuinty has required Ontarians to pay for the services they receive for which his government has been dubbed ‘tax and spend’ by people who would rather spend, borrow and pay interest.”

“Hudak’s election platform is the kind of document that made Greece the model of fiscal prudence it is today,” writes Gray.

CE LHIN tells Salvation Army to place closure plans on hold

The Central East Local Health Integration Network (CE LHIN) has asked Salvation Army Liberty Housing and Support to place their closure plans on hold.

OPSEU approached the CE LHIN and the Minister of Health’s office over last week’s unexpected layoff of the facility’s 11 staff. The union had argued that there appeared to be no process in place around the closure.

As a LHIN-funded health care provider, Salvation Army would be responsible for bringing forward an integration proposal to the LHIN. An integration proposal can mean closure of a service or transfer of those services to another provider.

In this case, no integration proposal was brought to the LHIN.

The LHIN also has the power to reject an integration proposal if they feel it is not in the public interest.

This week the LHIN dealt with a similar case – the Oshawa-based United Survivors Support Centre was facing closure. Services by the Centre were redistributed to Durham Mental Health Services and the Canadian Mental Health Association – Durham in an integration decision on Wednesday.

“While there is no guarantee that the service will not still close, at least there is now an opportunity to rationally look at these services and seek a way to either save them or relocate them to another provider,” said OPSEU President Warren (Smokey) Thomas.

Any integration proposal brought forward to the LHIN is required to include a human resources adjustment plan.