February 10, 2021

Attn: Hon. Peter Bethlenfalvy

Care Watch is pleased to provide input to the Pre-Budget Hearings. We are a not-for-profit advocacy organization. Volunteers run Care Watch, and seniors lead it. Our goal is that Ontario’s seniors receive the services they need to live safely at home and thrive in their communities.

These days, long-term care homes receive much of the attention. The deplorable conditions and preventable deaths anger us. Public outcry demands government action. Long-term care homes and home care aren’t separate. They are part of the same system. They serve many of the same clients and employ many of the same workers. Improvements in long-term care homes don’t have to come at the expense of home and community care. Instead, they can complement each other.

Home care is the first line of support for both seniors and the health care system. When seniors are living safely at home, they are less likely to appear in emergency rooms. They are also less likely to end up in hospitals or long-term care homes. Keeping people in their homes can relieve pressure on current long-term care beds as well as on the new beds being built.

It also makes sound financial sense. In 2020, the province’s own estimates showed that caring for a long-term care equivalent client at home would cost $103 per day. This contrasts with $201 per day in a long-term care home and $730 per day as a hospital alternative level of care patient. A National Institute on Ageing report [1] estimated that enhancing home and community care services could save the province between $212,259 and $268,369 in capital costs for every long-term care bed it no longer needs.

We have welcomed the funding increases for home and community services. These increases, however, follow years of neglect, and they haven’t kept pace with needs. Ontario’s population of seniors is growing, their needs are more complex, and some services have been transferred from hospitals to the community without adequate resourcing. Most home and community care providers are not-for-profit organizations. When government funding is not enough, they are forced to increase client fees, reduce services, or both.

Care Watch recommends:

• Making a home first approach a priority of the health system
• Immediately investing $350 million in home and community care organizations and services. Annual increases should exceed inflation to grow the sector
• Protecting funding to home and community care services so that it can be used only for these purposes.

In addition, we don’t have enough qualified front-line workers – personal support workers, nurses, and other providers – to provide care in the community. It’s becoming harder both to recruit new workers and to keep the ones we have.

Personal support workers in the community earn $3.57 less per hour and registered nurses nearly $11.00 less per hour than those working in hospitals. With the minimal increases to community agencies over the years, these gaps have widened. About 40% of personal support workers leave health care within a year after they graduate. In addition, about 25% of personal support workers who have two or more years of experience leave the profession each year [2]. The province estimates a current shortfall of 6,000 personal support workers across the health services system.

Care Watch recommends:

• A comprehensive health human resources strategy to build a pool of qualified care providers to work in the community
• Comparable wages, benefits, and working conditions for staff across health sectors
• More full-time work
• Improved working conditions – stronger pensions and benefits, along with paid sick days

The COVID pandemic has shown us what’s wrong with the way we care for seniors in residential settings. It has also shown us the problems when for-profit corporations are the ones delivering that care.

We know that solving these problems will take a long-term strategy. But Ontario’s seniors can’t wait. In the short term, we can make care safer both in long-term care homes and in the community.

Care Watch recommends that:

• Ontario introduce stronger regulations and consistent standards for all providers of congregate care
• Ontario immediately reinstitute regular, in-person, and at times unannounced inspections of care and infection control for all long-term care homes
• Long-term care home providers face consequences, including loss of licences, for failing to meet standards and remedy deficiencies within prescribed timelines
• When providers compete to provide structures and services, bidding processes, timelines, and requirements do not place non-profit providers at a disadvantage
• Non-profit providers be eligible for the same provincial development subsidies and assistance as for-profit providers

Older Ontarians want to hold on to their independence. Private sector retirement homes are financially out of reach for many of us. Ageing at home becomes the best, if not the only, choice [3]. Strong home and community support services can make that choice work.

As your government plans the funding of health and home care services, we urge you to give home and community support services adequate, secure, and dedicated funding.

Sincerely,

Michèle Harding, Chair, Board of Directors

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Footnotes:

[1] Bringing Long-Term Care Home, National Institute on Ageing, 2020 [back to text]

[2] Long-Term Care Staffing Study, Ministry of Health and Long-Term Care, July 30, 2020 [back to text]

[3] Care Watch, the Ontario government and others, have consulted with seniors over the past two decades. Seniors are overwhelmingly adamant that they want to live at home in the community for as long as possible. [back to text]