January 20, 2025

Standing Committee on Social Policy
Whitney Block, Room 1405
99 Wellesley Street W
Toronto, ON M7A 1A2
scsp@ola.org

Care Watch is a voluntary, non-profit, and non-partisan organization. We are led by older adults. We advocate for accessible, equitable, and high quality home and community services that support dignified ageing and enable older adults to age in place safely in their homes and communities.

Care Watch commends the government for having introduced the Support for Seniors and Caregivers Act. The Act contains several positive measures that will make significant improvements for Ontario’s older adults in (a) dementia care; (b) support to seniors, families, and caregivers; and (c) protection of older adults against abuse and neglect.

We support the announced investment in training in dementia care for the staff of long-term care homes, although we are disappointed that similar enhanced training is apparently not being provided to personal support workers working in home and community services. The additional funding for the Alzheimer Society First Link program is also welcome and will undoubtedly improve outcomes for people experiencing dementia. Also welcome is the expansion of support to caregivers of people living with dementia.   

The new funding for adult day programs and for respite care, as well as the commitment to expand Seniors Active Living Centre services, will provide much needed additional relief to informal caregivers who provide as much as 80% of the care received by older adults in Ontario. However, we believe an Ontario Caregiver Support Benefit, as proposed by the Ontario Caregiver Coalition, is also vitally needed as soon as possible. This benefit would provide monthly direct support to address the financial hardships associated with unpaid caregiving, initially providing $1,000.00 per month to eligible caregivers and then increased over time.

We also appreciate and support Bill 235’s proposed amendments to:

• the Fixing Long-Term Care Act, which aim to strengthen enforcement provisions to prevent resident abuse and neglect by introducing new offences related to abuse or neglect and enhancing government’s ability to investigate and prosecute such offences, joined with new requirements to recognize and respect the cultural, linguistic, religious, and spiritual needs of residents; and to
• the Retirement Home Act, which reinforce the right of retirement home residents to receive ongoing support from their caregivers.

However, we are concerned about the lack in both pieces of legislation of an effective enforcement mechanism and of consequences for breaching regulations and standards. The efficacy of employing provincial offences officers to investigate and prosecute offences and breaches depends on engaging and deploying enough officers who are appropriately trained to recognize regulatory breaches, especially neglect and abuse of residents; on consistent Crown prosecution of such offences; and on effective consequences upon conviction.

Notwithstanding Care Watch’s support for the positive measures contained in Bill 235, we are greatly concerned that this legislation does not address four major current challenges that are seriously jeopardizing the ability of home and community services to play their critical role in the system of supports for older adults in Ontario. These challenges, which need urgent government attention, are: 1) limitations on the accessibility of home and community services; 2) an inadequate human resource policy; 3) a lack of consistent provincial standards for home and community services; and 4) a flawed procurement process. 

Accessibility

The Ontario Health atHome system for assessing eligibility for publicly supported home care services is too restrictive. As result, many people do not qualify for home care services or, if they do qualify, they receive limited home care services that do not meet their needs for type and/or frequency of service. The provincial government needs to reform the assessment system to make it less restrictive and to gear it more closely to the self-assessed needs of people applying for home care.

There are also major barriers limiting access to home care in rural areas and remote communities, particularly Indigenous communities. The Ontario government needs to address these barriers by committing, in legislation, to making the same basket of home care services available to all Ontarians regardless of where they live.

Human Resources

It is critical to recruit and retain personal support workers for home and community care. Research indicates that a priority strategy is equalizing the wages and benefits received by community-based personal support workers to those received by workers in hospitals and nursing homes. The current inequality significantly contributes to high staff turnover rates that undermine the functioning of agencies providing home care and can adversely affect the quality of home care older adults receive. Increased investment in home and community care and the people who provide this care will reap significant return to provincial health care programming, including reducing emergency hospital visits and demands on other institutional services.

Standards

The Ontario government needs to establish provincial standards governing home and community services. These standards should apply both to the quality of care and to staff working conditions. Providers of home and community services should be held accountable for meeting provincial standards both through a system of regular, transparent, and publicly accessible reporting, and through penalties imposed on providers that breach standards.

Procurement

The process through for awarding contracts for providing home and community services needs to be reformed to give priority to non-profit providers over for-profit providers. Non-profit home care providers are embedded in their communities. As a result, they are better able than for-profits to provide locally sensitive and linguistically and culturally appropriate home care services. In addition, the reporting processes of non-profits are more transparent than those of for-profits. 

Furthermore, unlike for-profits, non-profit home care providers do not have to make payments to shareholders and, consequently, are able to devote all the public money they receive to providing home care services. However, despite these advantages of non-profit home care providers, they are currently significantly under-represented in home care services. It is estimated that about 64% of home care services in Ontario are delivered by for-profits and only 36% by non-profits.   

Care Watch welcomes the positive measures contained in Bill 235. However, we also call on the government to take the actions necessary to address the current challenges adversely affecting home and community services in Ontario so that these services can play their vital role in enabling older adults in Ontario to safely age in place.   

Sincerely,

Fiona Green and John Bagnall (Co-Chairs, Care Watch Board of Directors)