January 23, 2024

Care Watch welcomes the opportunity to contribute to Ontario’s 2024 Pre-Budget Hearings. To establish and maintain a sustainable home and community services system, we recommend that in 2024, government:

Meet growing needs and build consistent home and community services across the province with an investment of $290 million to:

• Increase service providers’ operational budgets by 3%
• Increase service volumes by 3%

Close the gap in funding for personal support workers in the community with investments of:

• $77 million for retroactive pay increases to stop wage inequality from growing worse as the result of Bill 124
• $116 million to keep pace with increases to personal support workers in hospitals and long-term care homes
• $50 million to apply the permanent $3 per hour increase to all hours of work

Explore additional investment in models designed to bring home and community services to settings with high concentrations of older adults with assessed needs

Needs are growing and we have to keep up.

The need for home and community services for older adults is growing, and it’s growing quickly. In 2023, adults 65+ made up nearly 20% of the population; by 2031, they are expected to make up 25%. In Ontario specifically, the population 80+ is expected to more than double by 2040.

Too many of these older adults are stuck in hospitals because there is nowhere else that is safe for them to live. When they stay in hospitals unnecessarily, their health and wellbeing suffer, and the system is deprived of beds that other patients need. Some of these older adults are waiting for beds in an already strained long-term care home system. However, many of them could live safely and productively in their own homes and communities if they had services that would meet their needs. COVID made many older adults even more resolute, with 91% of Canadians of all ages and almost 100% of Canadians 65 or older saying they planned to support themselves to live safely and independently in their own homes for as long as possible.

To keep about three-quarters of people aged 75 or older out of institutions, Ontario will need to plan for an additional 23,000 home and community care clients each year. This means expanding home and community support programs by at least 25%.

This expansion includes providing a consistent basket, or array, of services across the province. We recognize that needs will vary according to location and also according to the specific needs of each community. The needs of rural and urban communities will differ. For example, more remote and northern communities have greater needs for transportation services than do more densely populated areas. However, developing a basic array of services to be available throughout the province will help meet needs that have been emerging for some time and that will continue to grow.

Until 2023-2024, most home and community service providers hadn’t received an increase to base funding, so there is some catching up to do. Care Watch supports the Ontario Community Support Association’s recommendation of $290 million to:

• Increase service providers’ operational budgets by 3%
• Increase and expand service volumes by 3%

Community personal support workers earn less than anyone else in health care.

Personal support workers provide the majority of in-home services. They are the eyes and ears of home care and are often the first to notice changes in individual client needs. Their work is important, but each year 25% of them leave home and community services, letting us know that they can’t keep on doing those jobs. Some leave for jobs in other settings; others leave the profession altogether. The average vacancy rate in home and community services has gone from 7% pre-pandemic to 20% for key front-line staff today.

The personal support workers in home and community services have the same training and do the same work as those working in hospitals and long-term care homes. In addition, they now serve clients with higher needs than in previous times. Medical and technological advances now allow more people to receive even complex care in their own homes, so there have been sharp increases in the proportion of home care clients who need this care. Serving these clients places additional demands on personal support workers. Yet those in the community earn 19% less than those working in hospitals and 9% less than those working in long-term care homes. This is not only unfair; it’s also damaging. Depriving home and community care of qualified people compromises care. Service  shortages will force many older adults into more restrictive and expensive settings. They will also lead to crisis hospital admissions, thereby placing more pressure on an already overburdened system. When older adults lack the services that would keep them at home, it costs the system.

The wage increases of 2-4.6% in 2023 to community support services staff and home care staff were a start, but they were still far less than the 11% increase for hospital nurses and the 8% increase for emergency medical services. In addition, the $3/hour increase for personal support workers applies only to direct care hours, so those working in the community are penalized for traveling to clients’ homes and completing documentation – activities that are essential. The gaps continue to widen.

Care Watch supports the recommendations of the Ontario Community Support Association to:

• Invest up to $77 million for retroactive pay increases. These increases will help prevent the long-standing disparities from growing worse as the result of Bill 124 arbitration awards
• Invest $116 million in 2024 to keep up with increases to personal support workers in hospitals and long-term care homes and begin to bridge the gaps between sectors
• Invest $50 million to apply the permanent $3 per hour wage increase for personal support workers to all hours of work and not only to hours of direct care

Let’s cluster services where people need them.

Some buildings and some neighbourhoods have a high concentration of older adults and are natural settings for delivering home care services. Cluster care can make the most of these settings. In a cluster care model, a team of personal support workers and/or other health care workers is assigned to the setting. Care coordinators assess clients for need and eligibility. When workers visit, they provide care to all eligible clients in that setting.

A personal support worker spends the full shift in one location. Clients receive care as they need it, rather than by set blocks of time, and the length of each visit may vary depending on the client’s needs. Clients see the same personal support workers regularly. Those workers come to know their clients and can be immediately alerted to any changes. Clients receive more consistent care, and workers can be more flexible in meeting needs as they arise. Community non-profit agencies, which know their local residents well, are particularly well positioned to provide this care.

This model is a better use of time and resources than more fragmented care. When the personal support worker spends the entire shift in one location, travel time and associated costs are minimized. Time that would be spent on travel can be devoted to care.

Care Watch recommends that:

• Government invest in exploring models for cluster care, with a view to establishing three pilot projects – one in an urban area, one in a rural area, and one in a remote area – in 2024

A budget is an opportunity.

The National Institute on Ageing defines Ageing in the Right Place as “the process of enabling healthy ageing in the most appropriate setting based on an older person’s preferences, circumstances and care needs.” For most older Canadians, this is in their own homes and communities. 

Ontario has the opportunity to make long-lasting changes. Care Watch is heartened that government is investing in home and community services. These are the services that keep older adults safely and productively in their communities. They spare them and the system from the pain and high costs of institutionalization. We are pleased to contribute to the consultations on how this funding can best meet the needs of older adults and of the system as a whole.