Assessment of Ontario Progressive Conservative Party’s Platform on Home and Community Care Services

May 11, 2022

In the absence of publishing a platform for the June 2, 2022 provincial election, the Progressive Conservative Party of Ontario appears to be using its April 28, 2022 budget as the foundation for its campaign. We have therefore extracted the following information from 2022 Ontario Budget: Ontario’s Plan to Build.

This budget has been neither debated nor passed by the Legislature, and the Party has not committed, if elected, to reintroduce it. We must interpret it with caution.

The budget’s title is Ontario’s Plan to Build, and this emphasis is reflected throughout. It rests on five pillars: Rebuilding Ontario’s Economy, Working for Workers, Building Highways and Key Infrastructure, Keeping Costs Down, and A Plan to Stay Open. The budget is, therefore, “rich” on infrastructure from highways to long-term care homes.

In addition, it has been difficult to “do the math,” since some items in the budget were previously announced. We don’t know which numbers include those from earlier announcements and which represent new investments.

There is no specific section for health care or services. Instead, references appear in various places in the document. Following are excerpts from the budget that relate to home and community care. 

Expanding Home and Community Care

“People, including seniors, should have the option to stay in their homes and receive the care they need if they choose and if it is possible.” 

We can’t help wondering why “seniors” are separated from people in general. Are older adults not people?

“Home and community care keeps people healthy and at home, where they want to be, and plays an important role in the lives of more than 700,000 families annually. A strong home and community care sector is key to the government’s plan to end hallway health care and build a connected, patient-centred health care system. As Ontario continues its recovery, home and community care will play a vital role to enable seniors and others needing assistance to live independently in the community.”  

Care Watch appreciates these sentiments. We note, however that that the Party did not, in fact, make significant investments in home and community care until the last months of its mandate. Those investments were intended more to address pressures faced by hospitals and long-term care homes than to provide services to older Ontarians.

Additional Investments to Support Home Care

“Ontario seniors and recovering patients deserve to have the opportunity to stay in the homes that they love, where they are the most comfortable. Home care supports prevent unnecessary hospital and long-term care admissions and shorten hospital stays.

“Ontario seniors and recovering patients deserve to have the opportunity to stay in the homes that they love, where they are the most comfortable. Home care supports prevent unnecessary hospital and long-term care admissions and shorten hospital stays.

“The government plans to invest up to an additional $1 billion over the next three years to expand home care, improve quality of care, keeping the people of Ontario in the homes that they love, longer. The additional funding is intended to support home care providers, address rising costs and support recruitment and training as well as expand services. This investment builds on the 2021 Ontario Economic Outlook and Fiscal Review: Build Ontario investment of $548.5 million over three years to expand home care services.”

In its 2022 pre-budget submission, Care Watch asked for an immediate investment of $677 million followed by a stable and realistic annual investment for an increase in core funding and increases in wages and benefits for personal support workers to bring them in line with those who work in congregate settings.

There is no mention of how the funding of “up to an additional $1 billion” will be distributed and by whom. Care Watch has previously expressed concern about the lack of protection for home and community care funding which, according to current legislation, will be allocated through Ontario Health Teams via purchased services. We are also concerned about the increased privatization of home care services financed by public funds. 

“With these types of investments and other developments, such as virtual care options, care at home can become a choice that seniors, recovering patients and their families make instead of only relying on more traditional venues of care.” 

The meaning of “traditional venues” is not clear. Do they include hospitals and clinics or long-term care homes? Would they include Active Living Centres and service clubs or community support agencies and programs?

Having to travel to alternative locations for daily care can place an undue burden on some older adults and their families, many of whom are already stressed with the burden of care. Some may not own vehicles and may have limited finances to spend on travel. In addition, while useful to improve accessibility, virtual care has its limits. For example, many rural and northern communities still lack adequate and secure internet services. Some older adults may not be able to afford computer and internet services and the support that is often required. Some may find it difficult to manage self-care through virtual instruction. By default, caregivers, if available, will be further burdened with the task of managing this “virtual care.”

Introducing the New Ontario Seniors Care at Home Tax Credit

“Most seniors prefer to age in their own homes, surrounded by their loved ones and memories, and may require a range of supports to meet their unique needs and circumstances.

This is why the government introduced the temporary Ontario Seniors’ Home Safety Tax Credit to help seniors make their homes safer and more accessible. The government is now proposing a new, refundable Ontario Seniors Care at Home Tax Credit to help low- to moderate-income senior families with eligible home care medical expenses, including for attendant care, assistive breathing devices, and hearing and walking aids.” 

and:

“In 2022, this new Personal Income Tax credit would provide an estimated $110 million in support to about 200,000 low- to moderate-income senior families, or about $550 on average. Starting with the 2022 tax year, senior families would claim the new Ontario Seniors Care at Home Tax Credit when they file their personal Income Tax and Benefit Returns. 

See Annex: Details of Tax Measures and Other Legislative Initiatives for further information.”

This tax credit applies to the purchase of medical equipment and additional personal care services,  which can be out of reach for individuals on a fixed income. They may not be able to purchase equipment and then wait for a credit. Tax credits work only for individuals who have the income to benefit from them. For older adults with limited income, there is very little, if any, tax benefit, and $550 does not go far in purchasing equipment and attendant care. Moreover, the tax credit is temporary with no identified expiry date.

Helping Seniors Stay in the Homes They Love

“The government introduced the Ontario Seniors’ Home Safety Tax Credit for 2021 and 2022 to help seniors who want to stay in the homes they love, surrounded by the friends and families they cherish. The credit, worth 25 per cent of up to $10,000 in eligible expenses, helps cover the costs of handrails, stair lifts and other modifications to make homes safer for seniors. The maximum credit is $2,500 for each year. The credit will provide an estimated $65 million in support over 2021 and 2022. It is expected to support about 32,000 people in 2022.”

This statement rests on several assumptions – that older adults are all living in homes that they own (“surrounded by friends and families”) and that they can somehow manage to upgrade these homes. This is not always the case. Tax credits are meaningless for those who cannot afford the initial outlay. Even those who are able to get loans would receive no more than $2,500 – hardly enough to cover the cost. In addition, many older adults rent accommodations and might not be permitted to change unit infrastructure. Would the proposal also apply to landlords upgrading rental units?

If the $65 million covers 2021 and 2022, at least some of it has been previously announced and already spent. How much is left for succeeding years?

“Expanding Access to Community Care Ontario is investing nearly $100 million in additional funding over the next three years to expand community care programs such as adult day programs, meal services, transportation, assisted living services and caregiver supports. This investment will also stabilize and enhance sustainability for community services to support the well-being and independence of over 600,000 people in Ontario.”  

Care Watch supports expanding the Community Care Ontario program, but we need assurance that these programs and the funding will remain with not-for profit community care services, with there being no intent to include the private sector. We also question the program eligibility guidelines and who will be tasked with distributing the funds.

Expanding Community Paramedicine for Long-Term Care across Ontario

“The government is investing more than $60 million over two years, starting in 2022–23, to continue expanding the Community Paramedicine for Long-Term Care program to the 22 remaining communities and regions across Ontario. The program initially launched in five communities in April 2020 and has since been expanded to 33 communities and regions across the province. This means that more seniors across Ontario will get the care they need.”

The provincially-funded community paramedic program provides additional care for older adults who are awaiting admission to a long-term care home bed; eligibility for services is thus limited. The program, initiated as a pilot, operates in partnership with local municipalities which provide the paramedics. Care Watch generally supports the initiative, but notes that several issues are unclear: whether program expansion to “22 remaining communities and regions” is to be achieved by the end of 2024; whether the remaining communities are those that had been previously identified; and whether, in the longer term, municipal partners will continue to receive funding to support the partnership or be required to assume the full program costs when the pilot phase is complete. See news release from October 22, 2021.

 Increasing Investments for Ontario’s Dementia Strategy

“To support individuals with dementia and their caregivers, the government is investing an additional $5 million a year for three years. This brings total investment to $120 million over the next three years for dementia services across the province. This funding will support an additional 6,500 people in Ontario each year to live independently within their homes and to be engaged in their community.” 

Care Watch supports the expansion of programming for individuals with dementia and their caregivers. However, we question whether this money is separate or part of the $1 billion commitment to, presumably, community support services and other not-for-profit organizations.

Permanently Enhancing the Wages of Personal Support Workers

“Since October 1, 2020, the government has invested more than $1.3 billion to provide a temporary wage enhancement to more than 158,000 personal support workers (PSWs) and direct support workers (DSWs) providing publicly funded services in hospitals, long-term care, home and community care and social services.

The government is working to fulfil its commitment to introduce a permanent PSW and DSW wage enhancement by investing approximately $2.8 billion over the next three years to make the current temporary program permanent. The permanent wage enhancement will help to continue these important supports in the long-term recovery from the pandemic and to build a stronger and more resilient health care system that is better prepared to respond to crisis.”

There is no indication that any hourly rate for personal support workers in the community, in long-term care homes, and in hospitals will be equal or whether, as currently happens, community workers will earn far less than those in other settings. It is also unclear whether this amount includes benefits. If not, personal support workers will not be attracted to positions in homes and communities, but will instead choose those in institutions.