Our hospitals are bleeding

It sounded like a good thing. Last month’s Ontario Budget included a $160 million increase for hospital budgets for 2016. It was the first increase in five years.

Unfortunately, it’s a drop in the bucket compared to what hospitals need.

The whole package only amounts to a one per cent increase. With general inflation typically running at two per cent and health care inflation at more than four per cent, that’s a cut. In other words, the 2016 budget slashes hospital funding for the ninth year in a row.

Those cuts put lives in danger.

At St. Joseph’s Healthcare in Hamilton, there is a $26 million shortfall and 180 positions have been targeted for cuts. That will have a huge impact on the care that 1.8 million people rely on.

At Georgian Bay General Hospital in Midland, an operational review is calling for cuts to surgical and obstetric services. If the cuts go ahead, women would have to drive 40 minutes to Orillia or Barrie to give birth.

“The cuts to hospitals like St. Joe’s and Georgian Bay are happening province-wide, in every community,” says Sara Labelle, Chair of the Hospital Professionals Division of OPSEU. “The professionals who provide these services are trying to do more with fewer bodies.

“This is the systematic dismantling of hospitals and public medicare under the guise of ‘transformation,’” she said. “In healthcare, ‘transformation’ has become synonymous with cuts to services or privatization.”

Labelle said hospital cuts were hitting older Ontarians hardest.

“The ones who are paying the biggest price for the cuts are those that built medicare and paid taxes their whole lives.”

Rural and medium-sized hospitals are also struggling to survive because of funding changes. It used to be that hospitals in Ontario received a lump sum to cover their costs. That all changed when the Liberal government introduced a new funding model back in 2012. That’s when funding shifted from being provider-centered, which used to take inflation into account, to the so-called “patient-centered” approach that is in play today.

A patient-centered approach sounds like good thing. But when you break it down, it is anything but.

Here’s how the funding formula works now:

  • 30 per cent of a hospital’s budget is a lump sum payment;
  • 40 per cent of the budget is determined through a formula that takes into account the number of patients served and their health care needs;
  • The last 30 per cent is reserved for specific procedures such as hip and knee replacements, dialysis, and cataract surgeries.

The province funds those procedures at a set price (for example, $8,000 for a hip replacement) and for a number of patients determined by the Local Health Integration Network (LHIN). If a hospital ends up performing fewer of those procedures, future funding could go down. This is bad – especially for hospitals in small and rural communities. When hospitals receive money based on how many patients they serve, smaller communities get short-changed. More cuts are inevitable.

Providing a funding increase that is less than inflation might make it look like the government is saving our hospitals. It isn’t. Premier Kathleen Wynne needs to do much, much more.

Band-Aid solutions won’t stop the hemorrhaging at our hospitals.

Stop the cuts!

OPSEU members and health care activists in Hamilton aren’t taking the cuts to St. Joe’s lying down. Join us for a town hall meeting to find out more – and help plan the fightback.

Date:     Tuesday, March 29, 2016
Time:    7: 00 p.m.
Place:    Hamilton City Hall, Council Chambers, 71 Main Street West, Hamilton

More details here.

 

 

The real trouble with home care

Home care in Ontario is in crisis, and everybody knows it.

Patients know it. Home care workers know it. The Auditor General knows it. And now, the Government of Ontario knows it.

Back in December, Health Minister Eric Hoskins put out a discussion paper on how to fix home care. Patients First, he called it. The trouble with home care, the minister suggested, is the way government has structured it.

With that analysis, the solution was obvious: we need to restructure. How? Get rid of the Community Care Access Centres (CCACs) that manage home care now, and move their work into the Local Health Integration Networks, or LHINs.

There’s nothing wrong with restructuring, necessarily. No one will miss paying the jumbo salaries of the CEOs of the CCACs. On the other hand, the LHINs were created to download responsibility for health care from government to unelected regional officials. Their main purpose was political: to insulate cabinet ministers from unpopular decisions. So how handing home care to the LHINs will fix it isn’t clear.

The truth is, Patients First misses the real trouble with home and community care. The problem is two-fold.

  • First, health care is grossly underfunded. Under-funded hospitals are sending patients home sicker and quicker. When they get there, they can’t get the hours of home care they need because the community system is underfunded, too.
  • Second, private operators are crawling all over home and community care like ants at a picnic. In her September 2015 report, Auditor General Bonnie Lysyk found that only 61 per cent of the funding the CCACs received was going to face-to-face treatment for patients. So what’s happening to the rest of it? The 39 cents per dollar? It goes to private service providers who are in it for the public dollars. Some of those dollars go to managerial salaries; some go to profits. Far too few of them make it down to frontline workers, who continue to struggle with low wages and insecure jobs – despite the fact that they are looking after our loved ones. Thanks to privatization, we have no idea how hundreds of millions of health care dollars are spent. Private companies aren’t known for transparency.

On February 3, OPSEU members in the Community Health Care Sector met in Toronto to discuss Eric Hoskins’ discussion paper. They read the paper; they answered his questions. But their full response goes a lot farther than the questions the minister asked.

Do we really want high-quality, stable home care that spends public dollars wisely in a transparent manner? If we do, then there are two solutions: fund home care properly; and quit it with the privatization.

Read OPSEU’s full response to the minister here.

Why are we risking Canada’s blood supply – again?

The tainted blood scandal was the worst public health disaster in Canadian history. In the 1980s and 1990s, more than 30,000 Canadians became infected with HIV and Hepatitis C. This was due to government and bureaucratic failure to protect the blood supply. Tainted blood killed thousands. People are still dying from it today.

In 1997, the Royal Commission of Inquiry headed by Justice Horace Krever issued 50 recommendations to keep Canada’s blood and blood products safe. Public safety, Krever said, depended on five principles:

  • Blood is a public resource
  • Donors should not be paid
  • Canada should be self-sufficient in blood
  • Access to blood and blood products should be free and universal
  • Safety of the blood supply system is paramount

Canadian Blood Services (CBS), a nonprofit organization, was formed as a result of the tainted blood scandal. The CBS’s sole mission is to manage blood and blood products for Canadians (outside of Quebec).  It is based on the recommendations of the Krever Inquiry.

But the federal government has violated Krever’s principles by granting a license to a for-profit company named Exapharma/Canadian Plasma Resources (CPR). It  wants to pay blood donors in Saskatchewan. Plasma extracted from this blood would be exported. The clinic opened for business today.

In 2014, Canadian Plasma Resources (CPR) tried to open three private blood-collection clinics in high-risk areas in Ontario.  After a public outcry, the provincial government shut down the clinics and passed legislation to ban private plasma collection. (Quebec already had similar legislation.)

“The proliferation of private blood clinics in Canada would compound a three-decade tragedy and shatter the efforts made by those brave Canadians who fought to make our blood system safer,” says activist Kat Lanteigne, author of Tainted, a play about the blood crisis.

The World Health Organization (WHO) wants all profit-motivated plasma donations to end by the year 2020. There is too much risk in paid-plasma programs. WHO makes its persuasive case for a purely voluntary system in Towards 100% Voluntary Blood Donation: a global framework for action.

It is well documented by the European Blood Alliance’s (EBA) report in 2013 and by WHO that paying blood donors endangers the safety of the blood supply. Paying for blood draws donors away from our voluntary system. Paying donors attracts higher risk donors. They often lie about their health status to get the money.

In Europe, as reported by the EBA, German blood brokers bussed in poor donors from Poland. The practice has recently been restricted because the blood and plasma show higher infection rates.

In the United States, the economic collapse of 2008 generated a boom in for-profit blood companies. In Flint, Michigan, 100,000 people have been exposed to lead poisoning and legionnaire’s disease via contaminated water. Yet the publicly traded Grifols Company has not closed its paid-plasma centre in the area. It won’t until the U.S. Food and Drug Administration shuts them down.

Canadian Blood Services (CBS) would never allow Flint residents to donate into a public supply.  Not only are they high-risk donors, but they have compromised health and should not be allowed to donate.

Canada is self-sufficient in fresh plasma. Fresh plasma is used in the treatment for cancer patients and burn victims. We can’t afford to have competition in any collection because we will lose donors to our voluntary system. And that could risk the lives of Canadians.

Health Canada must reverse its decision and ban for-profit blood collection.

The chief executive officer of CBS has assured the public that everyone is getting the blood they need. If a shortage were to occur, CBS has the ability to collect more.

Some suggest that blood testing has progressed to where tainted blood can easily be identified.  But the new Zika virus has proven once again how fragile our blood supply is.

Please add your name to the petition to demand the federal government ban private blood collection in Canada.

“Care as a relationship” is key to good long-term care: research

What are long-term care residences around the world doing right?  That’s the question an international research team travelled across North America and Europe to find out.

Led by Pat Armstrong and Donna Baines, researchers visited nursing homes in Canada, Germany, Norway, Sweden, the United Kingdom and the United States, looking for practices that make long-term care centres feel like home to their residents.

diablogue fotoTheir findings won’t surprise long-term care workers. Good long-term care means building strong care relationships between residents and their care providers. Strong staffing levels, good working conditions, secure jobs, proper levels of public funding, full-service kitchens with in-house food service staff, and sensible standards – not onerous bureaucratic one-size-fits-all rules – lead to excellent care for residents.

The research by Armstrong and Baines resulted in a highly-readable, information-packed book called Promising Practices in Long-term Care: Ideas Worth Sharing (2015). A collection of short and moving vignettes from 13 long-term care homes is accompanied by solid statistics and eight recommendations for promoting care as a relationship. (Download it free here.)

Removing private profit leads to better care

The researchers found that non-profit nursing homes with adequate public funding were more likely to have better working conditions.  The links between good working conditions and strong care relationships with residents are obvious:

  • Adequate staffing levels ensure that staff have time to interact with residents;
  • Permanent, secure jobs with stable work schedules help residents get to know regular staff who care for them at predictable times;
  • Paid sick leave allows staff to rest when sick and avoid infecting residents at work;
  • Good wages, hours of work, benefits and pensions reduce staff turnover, which ensures continuity of care;
  • De-emphasizing excessive paperwork and charting allows staff more time to interact and socialize with residents;
  • Offering staff continuing education increases their ability to provide quality care for residents;
  • Having all services provided by in-house staff instead of contracting it out (e.g. food service, cleaning and laundry) results in better quality and more personalized care for residents.

These findings are in line with a recently-published study by the Journal of Post-Acute and Long-Term Care Medicine showing that for-profit nursing homes in Ontario have 16 per cent higher death rates and 33 per cent higher hospitalization rates than non-profit facilities.  For-profit homes also have higher rates of falls, incontinence, and use of restraints.

Focus on good food

The way to our hearts may not be solely through our stomachs, but good food makes a big difference to quality of care, Armstrong and Baines found.  Many of the promising practices in their book revolve around food.

Time and again, they found that long-term care residences where all meals are prepared, cooked and served onsite by their own staff provided much better meals, and better overall care for residents, than those who contract out food services.

When food is cooked onsite, residents can smell it cooking. It stimulates their appetites and makes them look forward to meals. Directly-employed food service staff get to know individual residents’ likes and dislikes. They interact with residents at meal and snack times, creating another continuous care relationship.

When food service is contracted out, strict meal times must be observed because contractors enter and leave at set times. But when in-house food service staff have food available all day long, or even 24 hours per day as it was in one residence in the book, there is no pressure for all residents to eat at exactly the same time.

This takes a lot of pressure off of other care staff as well. Care relationships are built through conversations and exchanges during and in between routine care tasks. In homes with flexible meal times, personal support workers don’t have to rush through care routines to get residents to the table by a set time.  That leaves time for relationship and trust-building.

In a care home in Germany, residents were even encouraged to help with the food preparation as they were able, with food service and personal care staff nearby to assist when needed.  This created a social atmosphere between residents and care staff, and fostered residents’ independence.  In a residence where food preparation and service is contracted out to private companies, this kind of interaction doesn’t have a chance to happen.

Time to care: Relationships over bureaucracy

Decreasing staffing levels lead to lower quality care, which then leads to bureaucratic rules requiring excessive documentation and the regulation of what should be common sense.

Personal support workers in Ontario often have to do well over an hour of routine charting every day – time they could spend assisting and interacting with residents.  In contrast to this, one Manitoba nursing home visited by the research team “charts by exception” – in other words, they only document occurrences that are out of the ordinary or things they specifically need to track.  This gives them time to build care relationships with residents.

In the nursing homes visited in Germany and Sweden, there was a greater focus on putting “more life into days than extending the days of life.”  A certain level of risk is accepted in exchange for quality of life.  Residents engage in activities that encourage independence, like food preparation using knives, or walking about instead of being pushed in wheelchairs. Residents with dementia who wander are watched and redirected by staff instead of being restrained or locked in. Staff have time to sit and talk with residents, meeting their socialization needs, not just their personal care needs.

But these practices require a high ratio of staff to residents.  The German nursing home above had staff to resident ratios as high as 1:3. In Ontario, there are no regulations for minimum staffing levels to ensure that other regulations are met, such as the provision of toileting assistance, repositioning, and other types of assistance.  Some Ontario PSWs are responsible for up to 42 residents at a time.

Good care also requires more staff time per resident. On average, residents in long-term care homes in Ontario currently receive the following:

This is well below the four hours of direct care per day that the Ontario Association of Non-Profit Homes and Services for Seniors recommends.

According to Armstrong and Baines, high quality long-term care could be the norm instead of the exception in Canada, if we had the desire and political will to make it happen. It will require a culture shift – a move from thinking of care for seniors in terms of a business model, to thinking about what long-term care residents need in order to live fulfilling, dignified lives.

Relationship-building cannot be legislated.  But we can create the conditions under which care relationships can thrive by setting minimum staff ratios and care hours per resident, creating better working conditions for staff, committing to strong public funding and removing the profit motive from long-term care.

OPSEU fights back against Wynne’s hospital cuts

OPSEU is ratcheting up the campaign against the Wynne government’s relentless attacks on Ontario’s health care system.  Here’s what’s happening across the province:

  • This week, the Ontario Health Coalition is rallying daily outside the pre-budget consultations being held throughout Ontario. Find out where and when the rallies are happening here. Join them!
  • This morning, OPSEU’s Hospital Professionals Division is launching a radio ad campaign to promote its new website PublicIsBetter.ca. Listen to the ad. Share it with your friends.
  • The campaign is being promoted on newspaper websites and Facebook.
  • A punchy online video shows the impact of health care funding cuts and how Wynne can start undoing the damage.

sad_hospitalThe goal is to put restoring our health care system on the Wynne government’s agenda.  Our treasured public health care system is suffering death by a thousand cuts. And it is happening with no public mandate.

For example, in 2014 Ontario brought in regulations making it easier to outsource community hospital services to private, for-profit clinics. These clinics typically take on low-risk, high-profit procedures such as cataract and colonoscopy services. This sucks money away from public hospitals.

Prior to the federal election, federal Liberal leader Justin Trudeau said that “some of our greatest achievements as a country – the things that matter in the daily lives of Canadians – came about when federal, provincial, and territorial governments worked together to forge solutions to complex problems.  One example that touches all Canadian, in a profound and personal way, is medicare.”

He also said that “our health care system isn’t perfect, but it represents the best of Canadian federalism. It’s flexible enough to respond to the different regional needs, while protecting the national principles Canadians hold dear.”

It’s time for that flexibility to kick in.  A good start would be for our premier to say to the prime minister that Ontario desperately needs federal financial assistance to rebuild a once-proud health care system in this province.

But Trudeau knows the Wynne government has only itself to blame for its supposed financial difficulties. Corporations in Ontario have enjoyed a windfall of tax cuts that started with the Harris Conservative government and continued under the Liberals.

These and other cuts are costing the provincial treasury $20 billion a year. So it may ring a little hollow when Wynne says to Trudeau that she needs help because the Ontario cupboard is bare.

Still, Trudeau must help rebuild Ontario’s once-cherished public health care system, and help other provinces as well.  But Wynne could make Ontario’s request more attractive by showing she is willing to do her part.  She should use her legislative majority to restore the corporate tax rate to earlier levels.  That would raise more than $2 billion a year right away.

Later this week the federal/provincial/territorial Health Ministers meet in Vancouver.  It would great if our Health Minister, Eric Hoskins, could truthfully tell his colleagues that Ontario is committed to restoring a strong public health care system.

Home care: the debate the government wants to avoid

Ontario’s malfunctioning home and community care system is a prime example of why private sector companies should not deliver health care. They don’t do as good a job as the public sector.  And the private sector is more costly.

The home and community system’s problems are so severe that Health and Long-Term Care Minister Eric Hoskins recently announced that the province’s 14 top-heavy Community Care Access Centres were being shut down.  Local Health Integration Networks will expand and absorb the CCACs’ responsibilities.

In making the announcement, Hoskins summed up what we have been telling the government for years:  “Too often, health care services can be fragmented, uncoordinated and unevenly distributed across the province. For patients, that means they may have difficulty navigating the system or that not all Ontarians have equitable access to services. Too often our system is not delivering the right kind of care to patients who need it most.”

The minister released a discussion paper asking Ontarians to tell the government how home and community care could be improved.

But perhaps the process should be reversed.  Perhaps the public should release a discussion paper and ask the government to respond.

Who made the decision to privatize Ontario health care by stealth? In what election did Ontarians vote for privatized health care?  When did Ontarians vote that our health care system’s primary goal be profit?

The government wants more treatment traditionally provided in hospitals relocated to the home.  This includes vital services such as dialysis, complex wound care and palliative services.

There are often good reasons for doing this.  Many patients recover more quickly after surgery if they rest at home rather than in the hospital.  And it costs less.

But as more health care services are transferred from the hospital to the home, the Wynne government is quietly transferring care delivery from the public to the private sector.  It is laying off workers in hospitals and contracting private companies to provide home and community care services.

But for-profit health care companies strive to make as much profit as possible.  That’s why they exist.

Ontario’s Auditor General recently looked at the level of care offered by home care providers that are under contract to Community Care Access Centres.  She found that only 61 cents of every dollar paid by the CCACs actually ends up going to face-to-face patient care.

What happens to the rest of the money?  The 39 cents per dollar?  Much of it goes to managerial salaries and profits of the for-profit companies.

These companies maximize profits by pushing down wages and forcing their workers to rush through their treatments.  For many, their mantra is “cheap and fast.”

But cheap and fast should not be the guiding principle of a health care system.  The guiding principle should be to do what is best for the patient.  This is the principle followed when care providers work for the government instead of the for-profit companies.

This should be the focus of public debate. But not surprisingly, Hoskins’ discussion paper doesn’t ask for comment on its privatization agenda. Privatization is a conversation the government desperately wants to avoid, because the facts show that privatization results in poorer patient care.

Where’s Linda Knight now?

OPSEU Information picket outside the Niagara CCAC offices March 19th.

OPSEU Information picket outside the Niagara CCAC offices March 19th.

When the unhappy staff at the Niagara branch of CarePartners first entertained the idea of organizing themselves into a union, CarePartners owner Linda Knight picked up the phone and called each of the workers. She promised that things would get better if only the front line home care workers gave her another chance before joining a union.

Nobody knows any of the financial details of Knight’s business – the for-profit CarePartners is not publicly traded and is therefore not required to report the details of its operations. Nor are for-profit companies working with public money required to post on the Sunshine list. We do know that in 2003 Profit magazine ranked Knight 33rd among the top 100 women business owners based on the firm’s gross revenues. Media reports suggest CarePartners had more than 500 nurses on the payroll – a huge leap forward from the kitchen-table nursing operation Knight started in 1984.

The fact that a prominent CEO and business owner would call about 100 workers pleading with them not to organize was extraordinary.

The gambit worked at the time, and the workers gave her another chance to make things better.

Knight never honoured that pledge.

Fool me once, but not twice.

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