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.
After significantly cutting outpatient physiotherapy at hospitals across Ontario, the government is finally putting something back.
The Ministry of Health says it is making a major investment in community-based physiotherapy, exercise classes and falls prevention services that will benefit up to 218,000 more Ontarians.
The Local Health Integration Networks (LHINs) will receive $10 million more for falls prevention and exercise classes – giving them an ability to serve 68,000 more seniors. This is in addition to $44.5 million to provide physiotherapy in community-based settings that will increase capacity to 90,000 more seniors and “eligible patients.”
These community-based settings could include Family Health Teams, Nurse-Practitioner led clinics and Community Health Centres.
Long term care homes will get the biggest share — $68.5 million for one-on-one physiotherapy with seniors in their care.
Community Care Access Centres are also to receive $33 million to reduce the wait list for in-home physiotherapy, giving them the capacity to add up to 60,000 clients.
Oddly the Ministry’s release suggests that “until now, a small number of for-profit companies have had almost exclusive control over the delivery of publicly-funded physiotherapy.”
Did they forget about the 50 per cent of hospitals that recently cut outpatient physiotherapy services?
Over the last number of weeks we have been debunking the myth that hospital cuts somehow represent service transfers to the community.
The data for 2012/13 is not yet available, but if we look at the volume of home care services delivered in 2011/12 we can see that for most clinical services, fewer visits –- not more — were delivered than in preceding years.
If hospital cuts truly represented a transfer to community-based services, shouldn’t these CCAC visits be rising, not declining?
The most obvious is physiotherapy. While Ontario hospitals are making significant cuts to outpatient physiotherapy, the actual number of physiotherapy visits delivered in the community by Community Care Access Centres (CCACs) and their agencies has dropped dramatically.
According to the Ontario Home Care Association, in 2005/06 there were 541,101 community physiotherapy visits. By 2011/12 that number had dropped by almost 100,000 visits to 444,054.
Here’s a given – as Ontario hospitals start to shed services and staff in the next three years, the government is inevitably going to proclaim the benefits of serving patients in the community.
The Canadian Institute for Health Information recently released a report showing Ontario has not only the fewest beds per capita in Canada, but the second least in the 34 country OECD (Organization for Economic Cooperation and Development). Only Mexico has fewer beds per capita – for now.
In fact, the number of Ontarians hospitalized in 2010-11 was not only the lowest in Canada, but it was down 33.5 per cent from what it was in this province during 1995-1996.
Tom Closson, the former Chair of the Ontario Hospital Association, told the Toronto Star June 22 that the province has lost 50 per cent of its hospital beds per capita over the last two decades.
Ontario has just two beds per capita for every 1,000 residents.
Sharon and Jackie (not their real names) are experienced physiotherapists nearing retirement. Both do exactly the same public home care work within the region covered by the Champlain CCAC.
Sharon works in the Renfrew area. Jackie works within the City of Ottawa.
The two began their community physiotherapy work as municipal employees in 1992 and 1988 respectively.
When the CCACs were formed, the service transferred from the municipalities to the provincially-run centres. While that also meant transferring from an OMERS pension plan to a HOOP plan, the physiotherapists were told they would experience no actuarial loss. This turned out not to be true, and has been the subject of a lengthy court case about to enter its second decade.
Cuts to outpatient rehab services are short sighted says Dr. Mark Bayley, author of a report on stroke services released this week by the Institute for Clinical Evaluative Sciences and theOntarioand Canadian Stroke Networks.
The lack of outpatient and CCAC rehab services mean many patients who would normally be able to go home end up in more expensive long term care facilities Bayley recently told the Toronto Star.
According to the 2011 Ontario Stroke Evaluation Report, patients are receiving far less visits than recommended from physiotherapists, occupational therapists and speech language pathologists.
Best practices suggest two visits per week from each of these professions. Instead over a two month period patients are averaging between three and four visits in total from each.
The report also notices considerable differences between the LHINs, calling for a more standardized approach for access to, and outcomes for, the rehabilitation sector.
InOntario only one in three stroke victims arrive at hospital in time to be considered for therapy that would dramatically improve outcomes.
While there was a reduction in overall wait times to stroke services, the report says there was also a reduction in access to inpatient rehabilitation among severly disable stroke patients.
The report also recommends the Ministry of Health Promotion continue to fund the warning signs of stroke television campaign.
The report did note that those taken to specialized stroke centers were more likely to receive care based on stroke best practices.
Between 2003/04 and 2009/10 there was also a reduced rate of emergency department visits and hospital stays for stroke or transient ischemic attack (TIA). TIAs are usually involve short term stroke-like symptoms and are considered to be a warning sign of a stroke.