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.
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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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For home care this is significant.
With their feet held to the fire by the NDP, the Wynne government announced last week they were going to invest $260 million in additional funding for home and community care services this year.
It was a significant enough announcement that the press release came from the Premier’s office, not from the Minister of Health.
Depending on how it’s allocated, this could be the single largest increase in home care funding since the Liberals came to power in October 2003.
Given the loose definition of “community,” we wonder how much of that will actually be delivered via the Community Care Access Centres and their contract agencies, and how much will end up at the Community Health Centres, Family Health Teams and other community-based provider organizations.
Unfortunately, they aren’t saying where this money will come from, only that it will be reallocated from elsewhere in the health budget. That could mean this “new” funding will also come with a sharp increase in demand from wherever the cuts are being made.
Part of that money will likely include the $33 million announced for physiotherapy delivered by the CCACs. That reverses a multi-year trend where funding for all home care therapies were being reduced at the same time as hospitals were being encouraged to reduce or axe outpatient rehab services. The end result for too many Ontarians was to pay out-of-pocket or go without.
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