Tag Archives: CCAC

Frustrated nursing staff quit CarePartners as OPSEU charges unfair labour practices

Photo of hands of health professional assisting an elderly female patient.

Nursing staff are leaving CarePartners in Niagara and Norfolk Counties as the employer thwarts efforts to secure a first collective agreement.
Photo http://www.canstock.com

Continuity of care is important to the delivery of home care. Each time a caregiver changes there is a necessary rebuilding of relationships. If caregivers are continually turning over, it is much more difficult to notice changes in the patient’s medical condition. For example, if a nurse never saw a wound before, how can she or he tell whether it is healing properly? Much of the care work is intimate in nature and subsequently relationships built up over time are important.

In 2003 the not-for-profit Victorian Order of Nurses lost the Community Care Access Centre’s visiting nursing contract in the Niagara region during a year in which the community was celebrating VON’s centenary. We were told over and over that the competitions were about quality, not necessarily price.

In the subsequent contract turnover one of the companies – the for-profit CarePartners – simply could not recruit sufficient experienced staff to successfully take over care from the VON. Instead they shuttled nursing staff from other operations around the province to do what they could to shore up their contract obligations. We heard first-hand patient stories about missed visits, about an inability to contact CarePartners over the weekends, about stressed staff rushing in and out to keep up with an impossible workload.

Of those few nurses who transitioned from VON to CarePartners, in 2005 we were unable to successfully argue in court that this represented a sale of business, and subsequently those workers were unable to retain their rights or union. Many of the VON’s original staff decided to find work elsewhere.

It’s more than 10 years later and the Niagara and Norfolk County staff of CarePartners chose OPSEU to help them seek a first collective agreement with the company. CarePartners is a much larger corporation these days thanks to an initial merger with Red Cross and the subsequent purchase of Red Cross’ home support operations.

Continue reading

Home Care: Giving and taking away

Photograph of ParaMed staff picketing outside of their Pembroke offices in July. 140 Renfrew County home care workers could be on strike as soon as September 2.

ParaMed staff picket outside their Pembroke office in July. 140 Renfrew County home care workers could be on strike as soon as September 2.

The government gives, the home care agencies take away.

Many of OPSEU’s home care agencies are presently at the bargaining table.

You’d think this would be the best of times for the professional and support staff that conducts the often difficult work of caring for Ontario’s homebound frail and elderly. Retaining this group of workers is also important to government bean counters who can add up the cost of lengthy stays in hospital by alternative level of care patients waiting for home care access.

Clearly of all sectors, home care has also become central to the government’s strategy to migrate services into the community.

So why can’t they get it right?

Ontario did recognize there is a significant problem with recruitment and retention in home care, taking what appeared to be a bold step towards increasing specific funding for the sector’s personal support workers (PSWs). PSWs delivered 72.3 per cent of all home care visits in 2012/13 and that percentage is growing as visits by licensed health professionals (nurses, dietitians, social workers and therapists) have been in decline over the past decade.

As we noted yesterday, the turnover is so high among home care PSWs that often the entire staff of an agency can change in less than two years.

Continue reading

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.

Continue reading

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.

Continue reading

Home care – it’s critical we get it right this time

Ontario’s Community Care Access Centres could have been very different had events unfolded differently in the early 1990s.

At the beginning of that decade home care was considered to have more of a leg in social services than health care.

The Rae government, like those that followed, were attempting to transition services from hospital to community and realized the potential of home care to look after patients discharged early from hospital.

The NDP were also sensitive to complaints that health care policies were being decided by the provider community, not by the users of the system. To that end, they not only encouraged widespread consultation, but even funded groups – particularly those representing seniors and the disabled – to speak to their communities and report back on what they heard.

That process was massive, involving more than 75,000 people, 110 provincial associations, 1,800 submissions and nearly 3,000 public meetings – all taking place within a five month window.

While the previous Peterson government had preferred more of a brokerage model – similar to today’s CCAC model which contracts to for-profit and not-for-profit agencies – the consultation process demonstrated that there was little appetite for a system most believed to be bureaucratic and fragmented.

Continue reading

Home care reform: how wrong are these incentives?

We probably wouldn’t have believed it had we not received the documents outlining the new plan for specialized home care funding.

It’s staggering in its ability to further complicate administration of home care and create so-called “efficiencies” for which the benefits would neither flow to the patient or the Ministry/LHIN/CCAC to facilitate more care.

Stuck with hundreds of contracts to supply home care and support services, the government has now decided it needs a new funding scheme to add to the long journey the modest health care dollar has to travel before reaching a home care client.

Keep in mind the home care dollar starts in the high altitudes of the Ministry of Health, where each spring it rushes down the slopes to the Local Health Integration Networks, where it pools and gently flows towards the Community Care Access Centres. From there it branches out from the CCACs into hundreds of small tributaries before reaching the home care agency. Sometimes that money is used by the agency to provide direct care by agency employees, other times it continues to trickle down to individuals who are treated as independent contractors. This is a journey that can often take the better part of a year for the home care dollar.

Within that long journey there are many eddies and pools in which this money gets trapped en route to serving the needs of Ontario’s home care patients. It’s one of the reasons why administrative costs for home care are conservatively estimated to be about 30 per cent (as compared to less than 10 per cent for hospitals).

It is at the CCAC level where the real action begins. The CCAC case managers, sometimes called care coordinators, assess clients, assign care services, and follow-up to ensure the client is receiving appropriate care. Often they have to play the role of advocate on behalf of their clients. They also play the role of system navigators and ensure a seamless transition to those in their care. New accountability requirements placed on these case managers have meant they have been able to spend less time face-to-face with patients and more time filling out paperwork. That has meant about $100 million more spent on case management between 2007-08 and 2010-11.

If that wasn’t enough, now the province is actually piloting a new funding and administration model, where much of the coordination presently done by the CCAC case manager is devolved to the private home care agency.

Continue reading

New Tory health plan is simple – too simple

The new Ontario Tory plan for health care is simple – eliminate the Local Health Integration Networks and the Community Care Access Centres and let between 30-40 “hub” hospitals run the health care system – or at least the bits not run by the municipalities or the doctors.

The new PC Caucus white paper, Paths To Prosperity: Patient-centered Health Care, is thin on specifics and long on rhetoric – much of it borrowed surprisingly from the McGuinty government. Aside from attacks on the LHINs and the CCACs, the broader strokes are not that different from the government’s own plan, including the Triple Aim we continually hear so much about. The “Triple Aim” sets goals to enhance patient quality and satisfaction, improve population health and reduce costs. Who could be against that?

While dumping the LHINs and the CCACs, the Tories would create physician-led “Primary Care Committees” which would link to the hospital hubs. The role of these committees is not clear beyond giving physicians more of a say in how the health system runs and somehow charging them with scrutinizing their own performance. How nice.

While this plan appears to centralize decision-making functions to the hospitals, the Tories counter that this represents a “decentralized and delayered” system. At the same time they sing from the George-Smitherman-Career-Memorial integration songbook. Decentralize and integrate? Confused? We all should be.

Continue reading

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.

LHINs grapple with data to make decisions

What is sufficient data to make effective decisions about the health system? What is the quality of that data?

Two issues came up at Wednesday’s Central East LHIN board meeting to illustrate both questions.

The LHINs across Ontario are balking at a lengthy list of performance indicators from the province they claim are “too many and too detailed.” The CE LHIN says it would need additional staff to keep up with the data stream the province is asking for.

James Meloche, a Senior Director with the CE LHIN, said the list of indicators was not strategic, leading departing board member Ron Francis to suggest the LHIN should be asking the province what they are planning to do with the data generated by these indicators.

Three different bodies are presently generating lists of indicators without any coordination between them. The LHIN says Hospitals are “maxed out” by the requirement for an every increasing stream of data.

For all the data that is presently collected, the veracity of it came into question in an exchange between Meloche and CE LHIN board member Samantha Singh.

Singh had questioned CE Community Care Access Centre CEO Don Ford on the large number of children awaiting speech-language therapy in the LHIN. Ford confirmed that the wait list for speech language therapy was between two and three years.

Meloche chimed in that the LHIN had previously only had 70 people on the wait list for speech language therapy– including both children and adults. After a recent blitz, he said that list was now down to 10.

Singh was incredulous; saying one school she visited had eight children waiting for speech language therapy.

The LHIN board also had a lengthy discussion about delays in getting data. At the April meeting the board was just getting results from the third quarter of last year. Paul Barker, a senior director of the LHIN, said reporting periods were “all over the map.” The third quarter data showed two hospitals in deficit, whereas in fact he said only one – Peterborough – would finish the year in the red.

With delays in getting data, the board is sometimes left making decisions on information that is six months old.