COVID- 19 exposes vulnerabilities of Ontario’s home and community care for seniors

We have all seen, heard of, or experienced the passing of a loved one in a seniors’ care home. Most of us are nauseated by the stark report from our armed forces on the conditions in five nursing homes, which the COVID-19 pandemic exposed; unfortunately, they are but the tip of the iceberg. It is not surprising that nearly 82% of Canada’s COVID-19 deaths have been in long-term care homes. For years, we have known about the risks.

Better quality and improvements in home and community care can keep seniors safely in their homes and out of more costly institutions, such as nursing homes and hospitals. But that system is again under threat. The problems we see now are not new, but the pandemic has brought them to the forefront.

Care Watch has been raising concern over the repeal of existing home and community care laws and transferring powers from somewhat accountable government ministers to less accountable private entities. This new legislation – “Bill 175 – Connecting People to Home and Community Care Act 2020” –needs Ontarians’ input before it goes further. We ask that the Ford government pause, debate, and then put viable solutions in place.

The current Bill 175:

  • Greatly reduces public accountability and oversight
  • Lacks consistency, transparency, and audit standards
  • Increases privatization of home care as well as parts of hospital and long-term care
  • Decreases protection for client rights
  • Lacks clear, consistent guidelines on complaints, resolutions, and appeals

Why is the Ford government rushing to implement Bill 175 when it has glaring shortcomings? Are the findings of the LTC Military Report not enough of a wake-up call? Have we lost sight of the value of human life? How large a role is ageism playing?

The Elephant in the Room. Funding Home and Community Care: Who Pays and How?

We believe that it is time for a serious conversation about funding a home and community care policy that parallels the Canada Health Act. Specifically: Who will pay for the system, how will they pay, and where will the money come from? We need to arrive at a consensus, and ensure that elected representatives (including future candidates for office) and public decision-makers know what we need and expect.

Stable, designated funding through general tax revenues – though politically and often personally unpopular – is the most feasible and workable approach, given the magnitude of the funds needed for a home care and community support services system. It covers the population completely and equitably and remains true to the fundamental principles of the Canada Health Act.

We summarized the various funding approaches argued for by scholars, journalists, politicians, and advocacy groups. Read about them and our other position statements here, or download our summary.

This Hour has 45 minutes and PSW Pay Cuts

Bob Hepburn’s commentary (Toronto Star. Aug. 4, 2016) [1] laments that raising the minimum wage for Personal Service Workers (PSWs) in the home care sector has resulted in reduced hours of service for clients and lower take-home pay for workers.  PSWs, who are paid on a piece-work or hourly basis, are now allowed to spend only 45 minutes per hour with clients, regardless of the client’s needs or the amount of work to be done, and are being assigned fewer clients.  The result for the PSW is less take-home pay, fewer or no employment benefits (e.g., sick, vacation or holiday pay), continued precarious working situations and increasingly rushed and frustrated clients.  The result for the client is less service and, for those with complex health problems, an increased likelihood of requiring more expensive hospital services.

Care Watch wonders why anyone is surprised.

The majority of home and community care workers are employed through private agencies; they are not “government” workers. These agencies must cover their overhead costs, and, in the case of for-profit agencies, their profit margins, through the budgets contracted via the CCACs. The obvious response was to cut back on hours of work and service provision.   The CCACs’ defense that services are based on need is disingenuous and not credible.

Back in June 2015, the Globe & Mail [2] reported that the Ministry of Health and Long-Term Care responded to a litany of complaints by providing guidelines to the LHINs intended to address inequities in the implementation of the phased wage increase and to deny any new business to agencies that would not agree to accept the raise. It appears that they failed to also address the usual strategy of reducing working hours and services as a response to increased costs that cannot be passed on to the client.

At that time, Minister Hoskins acknowledged that problems arose because his department did not know enough about PSWs in the home care sector. A year later, they should have learned a lot more and be in a better position to mitigate the problems that are arising.

Via the 2015 Patients First Roadmap [3], the province committed over a three-year period to raising investment in home and community care by $750 million (or $250M per year); increasing nursing visits a patient can receive at home above current maximums to avoid hospital or long-term care home admission; develop measures to create more permanent and less casual employment for PSWs (stabilize the work force); and address the challenges affecting recruitment and retention of PSWs.   The 45 minute hour and continued poor working conditions for PSWs are not meeting this commitment. Ontarians, and PSWs, deserve better.

 

[1] Toronto Star, Aug. 4, 2016. https://www.thestar.com/opinion/commentary/2016/08/04/how-a-pay-raise-turned-into-a-nasty-pay-cut-hepburn.html

[2] Globe & Mail, June 11, 2015. http://www.theglobeandmail.com/news/national/ontario-tightens-wage-increase-rules-for-personal-support-workers/article24921222/

[3]  Ministry of Health and Long-Term Care.  A Roadmap to Strengthening Home and Community Care.  http://www.health.gov.on.ca/en/public/programs/ccac/roadmap.pdf

Let’s think about the new Patients First Act before jumping on or off the bandwagon!

Introduction of Bill 210, the Patients First Act, 2016 offers a key opportunity for Ontarians to assess the health system changes that Minister Hoskins proposes.  These changes will have a significant, long-term impact on the range and quality of health services Ontarians receive through our publicly funded Medicare system. They will affect our experience as users, providers and taxpayers.

The draft legislation will amend approximately 20 pieces of legislation in order to implement the proposed reforms.  The Bill is complex and the way it amends these other Acts requires careful analysis of the intent as well as effects or probable outcomes.

Care Watch has a longstanding commitment to advocate for better, more accessible home care for senior citizens.  It is through this lens that we will be watching and commenting on the proposals.

Several commentators, such as The Toronto Star’s Bob Hepburn, note that it is a “first step” in the reform and restructuring process to reduce bureaucratic barriers, improve coordination, access and geographic equity for patients; facilitate patient transitions from hospital to home care; and reduce wait times for home care services, all while re-directing spending from management to front line services.  These are high hopes indeed, but Ontarians are capable of amazing things given sufficient political will and resources!

Also, legislation alone will not change the less than healthy culture of our health care system – affecting both providers and patients – which underlies or exacerbates many current problems.  Long term improvements will require changes in the way we think of and use health services, in our expectations and requirements, and in the ethos of providers we employ.

In the short term, changes will need to be carefully synchronized with appropriate transitional funding and risk management.

There is a lot to ponder.  Care Watch encourages senior citizens to think about the proposals and share your thoughts with us.  We will offer advice to Minister Hoskins through the public legislative committee hearings that the government promises to hold.

Board of Directors, Care Watch