March 27, 2020
Care Watch and Bill 175
On February 25, 2020, Ontario’s Minister of Health tabled Bill 175 – Connecting People to Home and Community Care Act, 2020, which significantly changes home and community care . There has been little, if any, public consultation. Care Watch is concerned that when government’s regular business resumes, the Bill could be pushed through quickly without clear information about how services will actually be delivered. This briefing summarizes our comments, concerns, and questions; it will be a springboard for other Care Watch communications. As the legislation and regulations evolve, our thoughts will evolve along with them.
About Bill 175
Bill 175 consists of three schedules addressing changes to key legislation:
- Schedule 1 – Connecting Care Act, 2019 (CCA) (Ontario Health, health teams, and funding, planning, and management). The government is moving the home and community care legislative frameworkto this Act
- Schedule 2 – Ministry of Health and Long-Term Care Act (MOHLTCA)(the obligations and authority of the Minister to oversee home and community care); and
- Schedule 3 – Home Care and Community Services Act, 1994 (HCCSA)(the current foundational structure for home and community care legislation, which Bill 175 repeals)
Bill 175 also makes amendments to five other acts  plus regulations.
Care Watch applauds the Ministry’s goal of modernizing home and community care. Many of our concerns, however, come not from what Bill 175 says, but what it doesn’t say. Specifics are left to regulation and policy – a crucial distinction. Before becoming law, draft legislation is subject to all-party debate and public consultation. Regulations, in contrast, can be passed, repealed, or changed at any time by Cabinet with no public input.
Local Health Integration Networks (LHINs) are re-branded as Home and Community Care Support Services, downgraded from public crown agencies to service providers, and eventually abolished. They are governed by one board and CEO and their functions dispersed. System planning moves to Ontario Health and regional planning for home and community care to the Ontario Health Teams. The LHINs/Home Care and Community Support Services will continue to coordinate and manage admission to LTC homes, supportive housing, chronic care and rehabilitation beds, and home and community care services until the health teams and others take on those functions. Ontario’s “…enduring commitment to the principles ofpublic administration, comprehensiveness, universality, portability, accessibility and accountability as provided in the Canada Health Act”  and commitment to “…equity and respect for diversity in communities…”  will be lost unless new legislation spells them out.
Unlike most legislation, Bill 175 has no statement of purpose or objects that reflect public interest. It also lacks definitions and descriptions. It essentially dismantles public governance of home and communitycare services, transferring key planning, design, delivery, and coordination functions to private (non-profit and for-profit) entities accountable to their corporate boards and not the public. Finally, there are no provisions to address access to care, equity, assessments, standards, quality, or staffing shortages.
Bill 175: Analysis of Some Key Elements and Changes
The Minister has made significant efforts to assure folk that nothing will change from a patient or client experience perspective and that people will continue to access services in the ways and from the sources they do now. Bill 175, however, doesn’t clearly demonstrate this claim. Following are some key elements of the Bill.
The government tells us that, if passed, the new legislation will make it easier for people to access home and community care in hospital, primary care, or community settings; help people connect with their care providers; and provide more choice for people with high needs to receive care in new community settings.
Bill 175 doesn’t support these claims. Transferring planning, coordination, and delivery of home and communitycare services to Ontario Health Teams (and their delegates) raises concerns that services will be fragmented and inequitable; inconsistent assessments will lead to inadequate care; and privatization will swallow the public interest. Following are some key questions.
- What is the government’s commitment to key public interest principles: public administration, comprehensiveness, universality, equity, portability, accessibility? Are the interests of the most powerful players in the system consistent with the public interest?
- How will prescribed services be defined? Who will have input into definitions and descriptions?
- How will Ontarians get the services they need regardless of where in the province they live and which Ontario Health Team serves their area? How will the cost of a particular service affect access?
- How will the Ontario Health Teams work? Who will do the coordinating?
- Will there be a consistent set of qualifications for all providers? How will not-for-profit service delivery be protected?
- What oversight will the government have over all service providers? How will clients be protected from rogue and dangerous caregivers? As virtual visits take on a larger role, how will clients’ privacy be protected?
- Who will be accountable to the public for service quality and equity and for use of public funds? How will the public know how, and whether, the new structures are working?
- Why change the legislation now, when fewer than 50% of planned Ontario Health Teams are even in development, and they are new and still untested?
 The umbrella term now being used for home care and community support services. The Bill is available at https://www.ola.org/en/legislative-business/bills/parliament-42/session-1/bill-175. A Ministry of Health summary of proposed regulations is available at https://www.ontariocanada.com/registry/view.do?postingId=31727&language=en
 Excellent Care for All Act, 2010; Health Protection and Promotion Act, 1990; Local Health Systems Integration Act, 2006; Health Insurance Act, 1990; Health Care Consent Act, 1996.
 Preamble. Local Health Systems Integration Act, 2006.