CCACs not entirely to blame for high home care administrative costs

What to do with the Community Care Access Centres?

Yesterday’s Toronto Star column by Bob Hepburn suggests we should roll them into the Local Health Integration Networks and send the CCAC CEOs packing. The urge to spank the CCAC board that approved a 50 per cent salary increase for their CEO is compelling, but blowing up the CCACs is likely not the answer.

There is no question that the CCACs are a very cumbersome way to deliver home care. Let’s not forget CCACs also are involved in discharge planning in the hospitals and coordinate placement into long-term care. They are also responsible for the Health Care Connect program that assists Ontarians to find family doctors or nurse practitioners. They directly employ nurses that go into schools to provide mental health support as well as rapid response nurses to assist with chronic disease management. Nurse practitioners are also working with palliative pain and symptom control.

Nobody seems to know how much of their work is taken up by administration. The CCACs say its 10 per cent, but that doesn’t count all the layers at the agency level. We don’t know what the CCAC spends on contract competitions or enforcement to existing home care providers. Let’s face it, accountability is not free.

Hepburn says administration and case management amounts to about 40 per cent, which seems to be as fair a guess as we’ve seen.

By anybody’s standard, that’s not the best bang for the buck.

The problem with the proposed alternative is the CCACs are not really parallel organizations to the LHINs.

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CCAC CEOs may not have enjoyed their cornflakes this morning

You would think the Community Care Access Centres would tread a little carefully these days. The Tories want to get rid of them. The Registered Nurses Association of Ontario would like to fold them into the LHINs. We’re creeping into the time of year where budgets run out and home care patients get left in the lurch, particularly around rehabilitation. It’s generally not a fun time for the CCACs.

The CEOs might be enjoying their day a little less this morning after Bob Hepburn’s column in the Toronto Star.  It left our spoons hovering above the Cornflakes.

Hepburn contends that the leadership at the CCACs have been handsomely rewarding themselves with lavish increases while applying restraint to the front line workers. Maybe it’s a last hurrah before it all ends?

Hepburn points to two examples – Cathy Szabo, CEO of the Central CCAC who saw her salary jump by 50 per cent from 2009 to 2012, and Melody Miles, CEO of the Hamilton-Niagara-Haldimand-Brant CCAC who gave herself a 24 per cent increase over the same period. For Szabo, her wage jumped $91,000 to $270,734. For Miles, her wage jumped during the same period by nearly $53,000 to $265,949.

The information comes from the sunshine list, which we always caution fails to give the full picture, including if the executives worked the full year covered under the report.

We decided to look at the rest of the list. Among CCAC CEOs, you have to really feel for North Simcoe Muskoka CCAC chief William Innes. Back in 2009 he reported earnings of $224,890. For the last two years it has been $199,877.

Central East’s Don Ford is the lowest paid CCAC CEO today. It’s true his kid’s likely didn’t go hungry with earnings of $180,769 in 2012, but the man has not had a raise since the economy took a dump in 2009. In 2009 Ford’s reported earnings on the sunshine list were $181,953. His taxable benefits are also far lower than many of his counterparts at $761.02 in 2012 (by comparison Catherine Szabo received $11,723 in taxable benefits). He’s at the bottom of the provincial heap.

Szabo and Miles draw down some of the biggest incomes among CCAC executives province-wide, but the biggest winner in 2012 was former deputy minister Margaret Mottershead,  who was then the CEO of the Ontario Association of Community Care Access Centres (and now she’s gone). Some may wonder why a small group of 14 CCACs needs an association, but we’ll leave that alone for now. Mottershead’s reported compensation for 2012 was $318,322, up slightly less than $5,000 from the year before. That would be a 1.5 per cent increase for anybody lacking a calculator.

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Picard blames health professionals for slow pace of “reform”

How can we improve Canada’s health system? Blaming the professionals who deliver care defies logic.

You may be very surprised to learn that one prominent journalist says the biggest obstacles to health care reform are the people who deliver it – or more specifically, their unions and associations.

Globe and Mail public health reporter Andre Picard comes back to so-called “vested interests” over and over again in a monograph (The Path To Health Care Reform: Policy and Politics) published last fall by the business-sponsored Conference Board of Canada.

Picard says of health care reform: “those who stand to lose the most are principally health professionals – specifically, the organizations that represent them, from unions to professional organizations.”

As such, so his theory goes, “they have a lot of power right now, and they’re not going to give up without a fight.”

Why would health professionals lose from health reform? Picard never says, although makes vague references to the poaching of professionals that is supposedly driving labour costs up. Really?

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NHH certified diabetes educators really do exist despite hospital denials

It’s one thing not to be acknowledged for the work you do. It’s quite another when your hospital says you don’t do that work at all.

Northumberland Hills Hospital (NHH) is saying that it “does not currently provide any specialized diabetes education for outpatients and inpatients.” For the certified diabetes educators at the hospital, this may come as a surprise.

The “integration team” is presently pushing forward a plan to bring in nurses and/or dietitians from the Port Hope Community Health Centre (CHC) to provide diabetes education not only to patients in the NHH’s dialysis unit, but to give best practices instruction to staff at the hospital. This is even though two seasoned certified diabetes educators are already on the staff of the Cobourg hospital and a third staff member is being supported towards certification.

There’s nothing worse for staff morale than telling somebody they don’t really exist, especially when they do.

Newly appointed NHH CEO Linda Davis may want to have a chat with her own certified diabetes educators before involving outside help. She could be surprised to learn that the expertise the hospital is seeking may be right under her nose.

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The real deficit and the phoney one

Economist Hugh Mackenzie has written two recent BLOG posts on the phoney deficit and the real one — the deficit in public services Ontarians rely upon. The Behind The Numbers BLOG is part of the work of the Canadian Centre for Policy Alternatives.

“There is no structural deficit in Ontario. There is a lingering, but
manageable, cyclical deficit – trumped up by a deficit crisis narrative
the government itself helped fuel two years ago.” Mackenzie looks at how the government has ramped up the deficit hysteria to cut public services. Does anybody care that each and every one of those government deficit projections was wildly off the mark?

http://behindthenumbers.ca/2014/01/29/the-staying-power-of-ontarios-deficit-games/

“The enduring and highly visible deficit in Ontario is actually its public services deficit. In 2010-11, public program spending represented 17.9% of GDP in Ontario. The McGuinty government planned to cut it to 14.6% of GDP by 2017-18. That missing 3.3% of GDP in public services spending amounts to $20 billion in public service cuts.” Yet as Mackenzie points out, we also reduced government revenues by cutting more than just corporate taxes.

http://behindthenumbers.ca/2014/02/03/tackling-ontario-public-services-deficit/

OANHSS calls for $135.4 million to cope with aggressive behaviours in Ontario’s nursing homes

Watching a sampling of presentations to the province’s all-party standing committee looking at the upcoming spring budget, many organizations are couching their language in the context of ongoing fiscal restraint.

Not so for the Ontario Association of Non-Profit Homes and Services to Seniors (OANHSS). Good for them. Ontario’s frail seniors shouldn’t be tagged to pay for the 2008 global economic crash.

While the government likes to talk about the transfer of services to the community, Health Minister Deb Matthews should take into consideration that lower acuity settings cannot maintain the same cost structures when higher acuity patients start becoming the new normal.

Simply put, the OANHSS states in their recent budget submission: “the nature of the LTC population has changed and the LTC system needs to respond appropriately.”

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Social Determinants: $11 an hour simply not enough

As health care providers news of the increase in minimum wage is important – as we stated in 2013, poverty is the second leading cause of death in this country.

While we have to applaud the government for finally promising to index the minimum wage to the cost of living – the legislation to do so has yet to be introduced – the reality is the adjusted rate simply didn’t go far enough. Even at $11 an hour, the wage is still 16 per cent below the poverty level for an individual who works full-time. And in Ontario there are a lot of people in that boat – the rate doubling since 2003 to 9 per cent of jobs in the province.

Kathleen Wynne told the CBC this morning that she was balancing the demands of anti-poverty groups with those of business, who warned that $14 an hour would lead to a loss of jobs. She said the government can use other means to help Ontarians get out of poverty, including the child benefit.

No doubt the business elites would be happy to have others pay the freight so that they can continue to pay workers a very low rate of pay while reaping significant rates of return for their shareholders. A low minimum wage essentially means we are willing to subsidize very profitable corporations so they can continue paying workers well below their true value. That includes increased health care costs.

More than a third of all minimum wage earners are working in the fast food industry. So how are these corporations doing?

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Why are six LHINs still afraid to let the community speak directly to their boards?

The Local Health Integration Networks spend a lot of time talking about community engagement.

In his 2010 report The LHIN Spin, the Ontario Ombudsman stated “the reality of community decision-making has fallen far short of the political spin.”

Andre Marin writes: “there are no clear minimum standards for soliciting community views on systematic priorities or specific integration plans, and different LHINs interpret their public outreach obligations differently.”

Marin picked up on the common complaint that while the LHINs regularly take steps to obtain local stakeholder views on the general state of the health care system, the performance has been less than adequate when it comes to changes that “have direct immediate impact on the lives of local residents.”

Following that 2010 report, the province issued a toolkit in the following year that proposed guidelines on LHIN community engagement.

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Briefs: TSH looking for $6.8 million in savings, Arnprior petition and more

The Rouge Valley Health System and The Scarborough Hospital officially filed notification to the Local Health Integration Network of their intent to merge, but it doesn’t mean hard times are over. Robert Biron, CEO of The Scarborough Hospital, sent a memo to staff Tuesday that reminded everyone that the health service provider still has a budget to balance. Biron estimates cost pressures of $8.4 million for 2014-15. The hospital has projected revenue increases of $1.6 million, but it still leaves them $6.8 million short. That shortfall represents about two per cent of TSH’s annual budget. Biron says it is the intention of the hospital to “minimize the impact” to services and staff positions where possible, however the memo gives notice that voluntary exit and early retirement packages will be offered soon. No specific cuts were identified in the memo. The TSH board will receive the budget plan on March 4th. Despite the formal notification to the LHIN, the hospitals will not make a final decision to merge for another 60 to 90 days.

In December we reported on a local fight-back campaign by the unionized staff (CUPE, OPSEU and ONA) at the Arnprior and District Memorial Hospital. The professional and support staff at the hospital are upset by the loss of six acute care beds at a time when the region’s population is rapidly expanding. Now our colleagues at CUPE have posted an on-line Avaaz petition for community members to sign that calls on the hospital to reopen the beds and staff them properly. If you’d like to add your name to the Avaaz petition, click here.

The Ontario College of Physicians and Surgeons has raised an interesting point around the province’s plan to shift endoscopies from hospitals to private Independent Health Facilities (IHFs). The College notes that IHFs are presently exempt from the Out of Hospital Premises Inspection Program (OHPIP) it conducts. Up until now endoscopy clinics have been considered community speciality clinics, not IHFs. In the most recent issue of the College’s Dialogue Newsletter, they state “the OHPIP model functions more efficiently and quickly to protect patients than the IHF model.” Despite the shift in status, the College is proposing to continue doing OHPIP inspections at these facilities. In 2011 the College warned that a private Ottawa endoscopy clinic failed to properly sterilize equipment and placed patients at risk of HIV, hepatitis B, and hepatitis C. The College also found that the clinic’s nurse was preoccupied with advancing the scope and not recording vital signs, that potential exposure to toxic fumes took place, single-use items were being re-used, and that cramped and cluttered premises posed a hazard by making it difficult to transfer a patient in the event of an emergency. Endoscopies and cataract surgery are at the top of the province’s list for divestment from community hospitals.

The more Ontarians understand the threat by PC leader Tim Hudak to end the Rand Formula, the less they like the Tories. While Forum Research president Dr. Lorne Bozinoff told the Toronto Star the anti-union policies are not seen as a massive wedge issue, “there’s some uneasiness that they’ve (PCs) just gone too far to the right.” The Forum Research Poll shows the Tories dropping in public opinion in tandem with declining disapproval of the Rand Formula. Those opposed to the Rand Formula dropped from 45 per cent to 38 per cent from November to January. Likely Ontarians are coming to understand that by undermining the province’s trade unions all labour rights are threatened – both union and non-union. The Forum Research polls still places the Tories in the lead at 36 per cent followed closely by the Liberals at 33 per cent and the NDP at 26 per cent. NDP Leader Andrea Horwath and Liberal Premier Kathleen Wynne share 40 per cent personal approval ratings while Hudak continues to lag behind with 21 per cent. In a press release issued yesterday, Bozinoff said “it appears Tim Hudak’s signature idea, ending compulsory union dues, is not a winner in Ontario, even among supporters of his own party.” The random sampling of public opinion was conducted among 1222 Ontarians 18 years of age and older between January 24-25.

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Matthews promises to improve PSW compensation — but it will take time

There may soon be good news for the province’s personal support workers.

“When PSWs tell me they can make more at Tim Horton’s, I sit up and take notice,” Health Minister Deb Matthews was reported to have said yesterday at the Empire Club of Canada.

According to the Toronto Star, Matthews promises to improve the wages of the province’s personal support workers but said it would take time to figure out the best way to do it.

Throughout December’s SEIU PSW strike at Red Cross Care Partners we pointed out that the minimum wage for PSWs has not been increased since 2006, frozen at $12.50 per hour. That’s below the poverty level for workers the province is counting on to make its health transformation work.

That minimum wage is far less than what former Health Minister Elinor Caplan had recommended in her 2005 review of competitive bidding in home care. Caplan recognized that there would be no continuity of care when PSWs were turning over due to poor wages and working conditions. The Star reports today that this turnover rate is 60 per cent annually – clearly the government should have listened. It’s not too late to listen now.

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