Nursing staff are leaving CarePartners in Niagara and Norfolk Counties as the employer thwarts efforts to secure a first collective agreement.
Continuity of care is important to the delivery of home care. Each time a caregiver changes there is a necessary rebuilding of relationships. If caregivers are continually turning over, it is much more difficult to notice changes in the patient’s medical condition. For example, if a nurse never saw a wound before, how can she or he tell whether it is healing properly? Much of the care work is intimate in nature and subsequently relationships built up over time are important.
In 2003 the not-for-profit Victorian Order of Nurses lost the Community Care Access Centre’s visiting nursing contract in the Niagara region during a year in which the community was celebrating VON’s centenary. We were told over and over that the competitions were about quality, not necessarily price.
In the subsequent contract turnover one of the companies – the for-profit CarePartners – simply could not recruit sufficient experienced staff to successfully take over care from the VON. Instead they shuttled nursing staff from other operations around the province to do what they could to shore up their contract obligations. We heard first-hand patient stories about missed visits, about an inability to contact CarePartners over the weekends, about stressed staff rushing in and out to keep up with an impossible workload.
Of those few nurses who transitioned from VON to CarePartners, in 2005 we were unable to successfully argue in court that this represented a sale of business, and subsequently those workers were unable to retain their rights or union. Many of the VON’s original staff decided to find work elsewhere.
It’s more than 10 years later and the Niagara and Norfolk County staff of CarePartners chose OPSEU to help them seek a first collective agreement with the company. CarePartners is a much larger corporation these days thanks to an initial merger with Red Cross and the subsequent purchase of Red Cross’ home support operations.
What to do with the Community Care Access Centres?
Yesterday’s Toronto Star column by Bob Hepburn suggests we should roll them into the Local Health Integration Networks and send the CCAC CEOs packing. The urge to spank the CCAC board that approved a 50 per cent salary increase for their CEO is compelling, but blowing up the CCACs is likely not the answer.
There is no question that the CCACs are a very cumbersome way to deliver home care. Let’s not forget CCACs also are involved in discharge planning in the hospitals and coordinate placement into long-term care. They are also responsible for the Health Care Connect program that assists Ontarians to find family doctors or nurse practitioners. They directly employ nurses that go into schools to provide mental health support as well as rapid response nurses to assist with chronic disease management. Nurse practitioners are also working with palliative pain and symptom control.
Nobody seems to know how much of their work is taken up by administration. The CCACs say its 10 per cent, but that doesn’t count all the layers at the agency level. We don’t know what the CCAC spends on contract competitions or enforcement to existing home care providers. Let’s face it, accountability is not free.
Hepburn says administration and case management amounts to about 40 per cent, which seems to be as fair a guess as we’ve seen.
By anybody’s standard, that’s not the best bang for the buck.
The problem with the proposed alternative is the CCACs are not really parallel organizations to the LHINs.
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
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.