Tag Archives: Frail Elderly

LHINs — It’s not so much what you put in or out

There are three issues that really coloured OPSEU’s initial relationship with the LHIN – both of them taking place long before the LHINs were even a concept in former Health Minister George Smitherman’s brain.

One is competitive bidding in home care, where contracts come and go, and so do the workers.

The second is the dramatic difference between what workers earn in the hospital and how they are remunerated in the community.

The third is the betrayal of mental health. Significant cuts to psychiatric hospitals were made and the promised alternate services were only partially re-established in the community.

In 2005 when we first learned of the LHINs, it sounded like more of the same.

The 2006 Act that brought the LHINs into being did make some adjustments to recognize the transition of health care workers between employers, but as one presenter to this week’s Central East LHIN board remarked, “often you enter in an integration and people are afraid.”

When people are afraid, they fight the change.

Long before the LHINs there was something called Hospitals In Common Labs. It is a non-profit corporation run by Ontario hospitals that does lab work for 250 health care provider clients from across Canada. HICL has generated $100 million in revenue over the last decade that has gone back into its participating hospitals. It is considered to be the gold standard for medical lab testing. It is therefore astonishing when the South East LHIN tells the media they had to make hospitals in their region play nice in the sandbox. Sorry SE LHIN, your hospitals were light years ahead of you. HICL has been around since 1967.

With a focus on transitioning work, often overlooked is the idea of keeping the work in place but cooperating as a system, as HICL has done.

To be fair, many of the integrations we are now seeing are more along these lines. At the Central East LHIN a proposal was looked at that would merge the two cardiac rehab programs in Durham with the goal of expanding the program and filling in gaps. The program – which involves weekly sessions with those at risk for heart disease, stroke and diabetes – can only be successful if they are delivered within a 30-minute radius of the patient.

Expanding the program would be a huge benefit to the region. Not only does it improve the chances of survival for a high-risk group, but it also improves quality of life, including a measureable reduction in anxiety and depression.

This week the Central East LHIN also spent time on a strategy that would bring together service providers to improve specialized geriatric services. That strategy includes a CEO-level committee to plan an entire system of care for frail seniors. By involving the CEOs, it ensures greater buy-in within the organizations. The proposal for an umbrella organization for frail seniors is timely – growth in the seniors population is expected to grow 19 per cent by 2019, at which time 47 per cent will be over the age of 85. There is desperate need for a more coherent approach to these services.

When Dr. Alex Hukowich left the board of the Central East LHIN, he made it clear that he was unsure whether the parts the LHIN was taking out of the system or putting into the system were of value.

Maybe that’s part of the problem – the need to pluck pieces out and put pieces back in is probably limited. Getting the various pieces to work as a system is likely the greater challenge.

To deal with that, the Ministry and the LHINs have to overcome a lot of history, including addressing some of our longstanding grievances prior to when the LHIN was even here.