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.
Above: Arthur Gallant — one of the more inspired choices for the Mental Health and Addictions Leadership Advisory Council.
Ontario Health Minister Dr. Eric Hoskins has been doing a lot of tweeting this week about the second phase of Ontario’s 10-year Mental Health plan. You may recall that the 10-year plan really was a three-year plan in 2011, which is being followed by another three-year plan now. We presume they’ll just continue making it up as they go along.
First the good news: The government is investing $16 million to create 1,000 more supportive housing spaces, opening a 12-bed paediatric residential treatment unit at Ontario Shores Centre for Mental Health Services, and spending $2.75 million to improve access to mental health and reduce wait times at four of the big psychiatric hospitals – The Centre for Addiction and Mental Health (Toronto), Waypoint Centre for Mental Health (Penetanguishene), The Royal Ottawa (Ottawa and Brockville), and the aforementioned Ontario Shores (Whitby). He is also creating a Mental Health and Addictions Leadership Advisory Council and is “partnering” with the province’s public health units to increase awareness, fight stigma, and promote mental health in schools and in the workplace. The largest chunk of cash — $138 million over three years — will go to community service agencies to increase access to peer support groups, treatment programs, and crisis and early intervention initiatives.
Now the bad news: It’s called perspective.
$2.75 million added to those four hospitals amounts to less than half a percentage point on the nearly $650 million a year they presently spend.
The $16 million in supportive housing will be over three years, or a little more than $5 million per year. There are 8,000 people presently waiting for supportive housing – just in Toronto alone.
Dr. Eric Hoskin, Ontario’s Health Minister, speaks about his top four priorities at HealthAchieve November 5.
Dr. Eric Hoskins may be signing his name, but the latest Toronto Star letter-to-the-editor from the Health Minister sounds as tired and exasperated as those served up by his predecessor. Given Ministers seldom pen their own letters, we conclude it must be hard to get good help these days.
Hoskins (or his ghost writer) insists that Star columnist Bob Hepburn is wrong – that in fact no cuts are taking place in home care. Never mind Erie St. Clair CCAC’s new executive director sent out a memo announcing a 33 per cent cut in daily nursing visits or that Care Coordinators at the Champlain CCAC are beside themselves having to recommend out-of-pocket paid alternatives to long-term patients who suddenly find themselves without a caregiver. Both CCACs are staring down millions in debt and are in freefall. But hey, aren’t we glad that no cuts are taking place?
It’s the same old song and dance coming out of the Minister’s office. Hoskins insists that Windsor got $3 million more in funding this year and that overall $270 million has been added for home care. Demand is far outstripping this funding due to a planned multi-year freeze to the base budget of Ontario’s public hospitals. Care Coordinators are telling us that not only is this placing the CCACs under great pressure, but it is changing the very nature of the work they are doing. It’s all about post-hospital care, not about longer-term chronic care management and support.
In this new video Anna Jover and Emily Visser highlight the voices of several OPSEU activists during Friday’s health care rally at Queen’s Park, including President Warren (Smokey) Thomas. About 5,000 Ontarians came from all corners of the province to protest the increasing privatization of hospital-based services. Earlier this year the province began holding competitions for services provided by existing public hospitals, including diagnostics and cataract surgeries. Those competitions were suspended by incoming Health Minister Dr. Eric Hoskins, but there has been no word from the Ministry whether this is a pause or whether the competitions would begin again at a later date. Further, the government has kept secret their commissioned Deloitte study that purportedly recommends the transfer of specialized medical laboratory testing to the private sector. When the Local Health Integration Networks were established labour complained that such destructive competitions that left shortages of caregivers in home care would be extended to public hospitals. At the time the government suggested this was no more than scaremongering.
Dr. Eric Hoskin, Ontario’s Health Minister, speaks about his top four priorities at HealthAchieve November 5.
Ontario’s health minister has what he calls Health Plan version 2.0.
Speaking at the closing of the Ontario Hospital Association’s annual HealthAchieve conference, Dr. Eric Hoskins revealed his top four priorities after less than five months on the job.
Few would disagree with them given they fit well within the modern paradigms of health system redesign, but getting there may be a different story.
It’s not surprising that a redesign of home and community care is the first priority. News from the Champlain CCAC must be vexing the new Minister as patients in need of long term home support are being dropped from care and the bar has been set exceptionally high for new patients to access service. Sadly, CCAC staff have been told to direct patients to paid out-of-pocket forms of care or to social service agencies with long waits, raising the question whether the government is letting the principles of Medicare slip away under Hoskin’s watch?
The Champlain CCAC continues to lurch from crisis to crisis. Is it time for the province to intervene — again?
“It’s a question of how we can do work more efficiently and maybe less people.” – Patrice Connolly, vice-president of people and stakeholder engagement, Champlain CCAC.
The Ottawa Sun is reporting the Champlain CCAC has cut services to a patient who has multiple sclerosis and cannot bathe, dress, or cook. Without his visits he cannot also do the exercises needed to keep him from stiffening up.
Over the summer Champlain realized that it was headed for a $6.8 million operating deficit and reset the threshold for personal support services to an assessment score (RAI) of 15.5 – this on a scale that goes to 28.
Further, staff have been told to instruct patients in need of care how to access other services, “many of which have a co-pay fee.”
States the Champlain CCAC in their June minutes: “staff recognize this is a hardship for clients and families, however the Champlain CCAC must also work within the budget it is provided.”
July 8 the Ontario Health Coalition brought more than 80,000 signed cards to the Ontario legislature opposing the transfer of clinical services from hospitals to private clinics. (Photo courtesy the Ontario Health Coalition)
The media is applauding Health Minister Dr. Eric Hoskins this week for promising greater transparency around private clinic inspections that had previously been kept secret by Toronto Public Health and The College of Physicians and Surgeons of Ontario (TCPSO).
Tom Closson, the former President and CEO of the Ontario Hospital Association, suggested in the Toronto Star last week that “bringing out-of-hospital clinics up to the same standard as hospitals regarding transparency would increase public confidence in the care they are seeking.”
Ontario’s Action Plan for health care includes systematically taking clinical services out of public hospitals and transferring them to a sector that has a history of two-tier medicine, questionable user fees, unnecessary up-selling, significant quality control issues and too little transparency. The latest revelations, particularly around infection control at several private clinics in Toronto, may have persuaded the government not to carry out spring and summer competitions for selected hospital clinical services – at least for now.
They may have learned from the Ottawa Hospital’s ill-timed decision early in 2013 to divest 5,000 endoscopies to the private sector at the same time the TCPSO was making public the list of clinics that failed inspection public – including one Ottawa endoscopy clinic that may have exposed patients to HIV, hepatitis B and hepatitis C from equipment that may not have been properly sterilized.
This spring the Ontario Health Coalition collected more than 80,000 postcards expressing opposition to the transfer of services from public hospitals to private clinics. Without any clear indication from government whether the competitions are on hold, the coalition is now working towards a November 21st mass rally in Toronto to push further on the issue.
More than nine months after expressing Ontario’s intention to retain PSWs, implementation continues to hit major bumps in the road.(CanStock Photo)
In 2010 a provincial coalition of experts was assembled to look an integrated hospice palliative care system in Ontario.
Hospices are a specialized residential facility for palliative care patients. As the coalition’s report states, “hospice palliative care is a philosophy of care that aims to relieve suffering and improve the quality of living and dying.”
To do that the government relies on these hospices to produce a substantial portion of own-source revenue, most of that coming through fundraising.
Among the many recommendations in the four-year-old coalition report is one to increase the percentage of public funding for Ontario’s hospices to 80 per cent of their operating expenses. Presently it is about 50 per cent.
It may be wise to keep that in mind as the hospices now grapple with unexpected costs associated with the government’s initiative to improve PSW wages and address the sector’s ongoing recruitment and retention issues.
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.