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Ontario presently provides more than 29 million hours of home care per year. Another 20 million hours are paid for out of pocket or through private insurance.

The NDP are promising another million hours, the Liberals are offering three million.

According to the Ontario Home Care Association, while the hours of care are up, the number of patients served in 2009/10 was about 45,000 fewer than in 2005/06.

When the Liberals increased the cap on how many hours of care an individual could receive, they did not put sufficient resources into the system to deal with the actual draw on services. With more patients discharged in worse condition from hospitals, the “clients” home care agencies and CCACs see are also much more labour-intensive.

Further, as a percentage of overall health care spending, home care has been in a slow but steady decline. In 1999 it made up 5.47 per cent of public health care spending. By 2009/10 it took up 4.13 per cent.

This is at a time when hospitals have been pushed to clear their beds of so-called “alternate level of care” patients, putting more pressure on the CCACs and long term care homes.

It presently cost $1.9 billion to provide Ontarians with public home care visits.

Where will the money from these new commitments come from?

The auditor looked at the government spending projections prior to the beginning of the election and concluded that base home care increases would be two-thirds less than the existing pattern. That means their base assumptions for funding are far less that the status quo. So, would Ontario need to cut home care before it adds the million, or three million hours? This doesn’t make much sense.

This is what the Ontario auditor had to say: “We were advised that a key strategy for containing growth in hospital expenditures is increasing community home care support and long-term care availability to enable more acute or alternative levels of care for patients discharged from hospitals. Because this will increase demand and therefore expenses for both long term care homes and CCACs, which currently already have wait lists, we concluded that the government’s assumption that both programs will be able to significantly reduce their annual expenditure growth rate is optimistic rather than cautious.”

The NDP have stated that they would take on the competitive bidding system, which they assume would free up $25 million by 2013/14 and $100 million by 2015/16. They plan to begin by conducting a review of the present system with the goal of moving towards a more publicly-delivered home care.

The Ontario Home Care Association insists that administration only counts for 10 per cent of budgets, but that calculation leaves out the administrative work conducted by CCAC case managers. While not all of the case managers’ work is administrative, case managers account for 23 per cent of CCAC costs. The association’s calculation is likely to leave out the cost of preparing bids, evaluating bids, severing employees, hiring replacement workers, and other consequences tied to the present bidding process. The Ontario Health Coalition estimates the current system has led to administrative costs at least at the 30 per cent level.

The Tories are much vaguer about their home care projections, likely a result of having a platform with the highest level of spending restraint. According to the Toronto Star, they plan to spend $175 million more on home care. They are also promising 5,000 new long term care beds.

Hospitals are required to post quality information on-line, but most Ontarians are not looking.

In a July Vector Poll, only 25 per cent of respondents said they were aware of quality information posted on-line. Slightly fewer, 24 per cent, said they looked for hospital information on-line.

Among older users, those more inclined to be using the system, fewer are using these resources. Only 16 per cent of respondents over the age of 55 said they ever looked for information on the website of a hospital in the province.

Among those who have gone on-line, 25 per cent said they found the information hard to understand.

Only 27 per cent of Ontarians said they were aware of Ontario’s wait times website and only 16 per cent said they have visited it to take a look.

While there is support for making information public, more than two of three (68 per cent) Ontarians said it was more important for government to monitor hospitals to make sure they met minimum standards for quality care.  

British epidemiologist Richard Lilford warns that on-line comparisons can be dangerous: Lilford says if the public uses online comparisons as report cards on good and bad hospitals it could encourage hospital administrators to turn away patients with the poorest health or the worst chance of recovering. This “may lead to overly aggressive care, which is inhumane and drives up costs.”

The findings are based on interviews conducted July 12-21, 2011 of 1,106 adults across Canada, 502 in Ontario. The Ontario sample error is plus or minus 4.4 percentage points.

What is the value of corporate tax cuts? How many jobs were created for that money? Operation Maple takes its corporate tax quiz to the streets.

Don’t forget to pick up your Hospital Professional Division “Tax Cuts or Health Care?” bumper magnets. You do have a choice on October 6.

Operation Maple is an on-line video site that takes an alternate look at the news. Check it out at:

www.operationmaple.com

Operation Maple interviews a mental health patient about her experience in prison. It is estimated that as many as 90 per cent of women inmates locked up in our corrections system suffer from some form of mental illness.

Ontario Hospital President and CEO Tom Closson is stepping down from his post in January 2012. He is still planning to lead the OHA through the October provincial election and the immediate post-election period.

The election may be an interesting dynamic given Closson is on record as advocating for more money to be taken out of the system at a time when politicians of all stripes are advocating staying the course and maintaining modest funding increases.

Hospital CEOs must have been shaking their heads when their leader told the Empire Club last October “we have to find ways to take money out of the system, so I think we need the leadership from government.”

Closson praised former Premier Mike Harris and his restraint on the system, never taking into account its longer term effect on his own membership or its impact on present-day costs.

At a time when his hospitals were struggling to balance budgets and find ways to push more patients with higher levels of acuity out into community care, Closson instead spoke about eliminating waste.

The Empire Club speech was certain a surprise. Months earlier Closson told the provincial finance committee that progress on wait times and public confidence in the system would be eroded with less than a two per cent increase in funding.

Despite promising to open up hospitals to greater public scrutiny, Closson wrote bizarre and insulting letters to labour and community organizations who argued against Schedule 15 of Bill 173 — the so-called “hospital secrecy act.”

Closson fought publicly with the Ontario Medical Association in 2009 over Bill 179 which expands the scope of practice for pharmacists and nurse practitioners. Confrontational, Closson publicly derided the OMA’s “retrograde ‘policy’ paper” and accused them of protecting their own turf.

Arguing physician costs were higher in Ontario than any other province, Closson’s wrote “this disparity, coupled with OMA’s adamant defence of physicians’ status, has prompted reasonable people to question whether taxpayers are getting the system leadership they deserve from the OMA.” Ouch.

Closson was never shy about pressing the alarm bells on rising health care costs, nor was he shy about extolling the results of such increased expenditures, particularly around reduced wait times.

Under his watch targeted funding became a greater feature of hospital budgets while global funding was in decline. With Queen’s Park determining how the money would be spent, it left hospitals with fewer opportunities to make decisions locally.

While hospitals were forced to come and explain themselves before the LHINs, bringing in so-called “hospital improvement plans” that included major layoffs and cuts to services, Closson remained a staunch defender of the planning agencies and their role.

Closson was never shy about advocating that more of the work performed by hospitals be conducted elsewhere.

“The answer is in the community,” he has said, often repeating the story of his father who was unable to leave hospital for five months due to an inability to place him in community-based care.

Following the ombudsman’s damning June report, the McGuinty government promised to regulate private hospital transfer companies. Closson was warned about the dangers of this unregulated business in 2009 – including unclean vehicles, poorly-trained staff and risk of infection — but was indifferent to concerns when confronted by investigative journalist Tina Pittaway.

He told Pittaway the hospitals were satisfied with the arrangement and that the OHA had bigger issues to deal with in the health system. This is despite the OHA calling for regulation back in 2004.

The OHA has been obsessed in recent years with the idea of moving so called “alternate level of care” patients out of hospitals. ALC patients are those who have completed their acute care treatment but are unfit to go home without ongoing care. Under pressure, several hospitals threatened these patients with steep daily fees if they did not take the first long term care bed available – even if it meant travelling outside their home region. The threats backfired, resulting in the province having to step in to ban the practice.

Hospital crowding has likely been a determining factor in the latest crisis. C-Difficile has spread through about 10 per cent of Ontario hospitals contributing to at least 26 deaths.  At least two hospitals — the Etobicoke General site of the William Osler Hospital and the St. Mary’s Hospital in Kitchener — have also reported bed bug infestations.

Closson was appointed CEO and President of the OHA in 2008. An engineer with an MBA, he has served as CEO of the University Health Network, Sunnybrook Health Sciences Centre and CEO of the Capital Health Region in Victoria, BC.

Closson obtained previous experience in health care consulting as an owner of Medicus Canada and as a Partner with KPMG.