OPSEU President Warren (Smokey) Thomas (far right) with striking ONA CCAC professionals in Kingston last Friday.
About 3,000 professional staff at nine of the 14 Ontario Community Care Access Centres started walking a picket line Friday.
Represented by the Ontario Nurses’ Association, it’s the latest labour disruption in a sector the government considers to be critical to its overall health strategy.
About 140 OPSEU home care workers at ParaMed Home Health Care in Renfrew withheld their services last September after their agency initially failed to negotiate a deal that would lift many of its workers out of poverty. In 2013 SEIU took 4,500 personal support workers at Red Cross Care Partners out on strike over similar conditions. Following that strike the government implemented a well-intentioned but poorly constructed initiative to stabilize the Personal Support Worker (PSW) workforce by increasing funding for their wages over three years. As the government passed on wage increases for these PSWs, some private for-profit home care agencies clawed back compensation for travel time and mileage. In Niagara and Norfolk Counties OPSEU’s nursing staff at CarePartners are likely to strike soon to gain a first contract.
Health Minister Dr. Eric Hoskins has appointed former RNAO President Gail Donner to lead an expert review on the sector. Her recommendations are expected early this year. They can’t come soon enough.
The pressures during this latest strike will be tremendous given Ontario’s underfunded hospitals have little room to maneuver now that the ability to discharge home care patients to the CCAC has become much more limited.
The CCAC boards are looking particularly ridiculous. The Toronto Star reports that ONA was asking for a 1.4 per cent hike for its workers after emerging from a two-year wage freeze. To most people, that seems more than reasonable in the face of the lavish wage increases the CCAC boards have been bestowing on their CEOs.
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Tagged CarePartners, Community Care Access Centres, Don Ford, Dr. Eric Hoskins, Gilles Lanteigne, Jacqueline Redmond, Mary Elizabeth Kuchta, Megan Allen-Lamb, Melody Miles, ONA strike, Ontario Nurses' Association, ParaMed Home Health Care, Red Cross Care Partners, Richard Joly, Sandra Coleman, Warren Smokey Thomas in Kingston
When the province decided to call its most recent crown agencies Local Health Integration Networks, it was clear where the emphasis lay.
Rather than plan a system based on need, it appears the primary function of the LHIN was to ‘integrate’ health services.
Integration can be broadly interpreted – it doesn’t necessarily mean mergers of health providers, although it can be. It can also mean greater cooperation and collaboration between providers, or transfers or even swaps of services from one entity to another. Under the Act’s definition, integration can also be the winding up or closure of a service – something most of us would not see under the normal dictionary interpretation of ‘integration.’ The extension of that illogical concept is that by blowing up the entire health system you’d have full integration.
It seems the province was short a philosopher when they needed one.
The province maintains that about 250 integrations have taken place since the LHINs came into effect in 2006 – most being of more recent vintage. That surprises us given much of the system seems to be still dipping a toe into the integration pool.
Some integrations happen by default. Sometimes a small agency just decides it can’t continue any more and the LHIN is left scrambling to transfer the work to another health provider. Perram House hospice, for example, gave the Toronto Central LHIN just a couple of weeks notice to say they were calling it quits.
Just because a service transfers from point A to point B, doesn’t mean that the system as a whole becomes any more fluid or patient-centered. Sometimes it makes it worse.
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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.
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Tagged CCAC, Coalition home care roundtables, Community Care Access Centres, Competitive bidding, George Smitherman, Home care, Hudak position on home care, Liberal position on home care, NDP multi-service agencies, Ontario Community Support Association, Ontario Health Coalition, VON
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.
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