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Critics say province should slow down plans to revamp home care

Posted: June 16, 2020

(June 15, 2020)

By: Elizabeth Payne, Sudbury Star

Ontario says it is breathing new life into an outdated system, but critics say the province’s plan to revamp home care in the middle of a pandemic is reckless and will cause further chaos for those most affected by COVID-19.

In March, critics complained the Ontario government was rushing through Bill 175, which will turn the home-care system on its head by dismantling its coordination system, among other things.

Now the Ontario Health Coalition and unions say they are shocked the government is continuing to push ahead with the sweeping legislation in the midst of a pandemic that has disproportionately hit seniors, who are the main clients of the province’s home-care system.

Several days of hearings on the bill titled Connecting People to Home and Community Care are scheduled for this week.

The proposed legislation, which fits into the province’s move to replace the local health integration system with locally run Ontario health teams, repeals existing home- and community-care legislation. Critics say it is vague and leaves too much uncertainty, which will further destabilize the home-care work force.

“Right now, we have enough instability going on,” said Natalie Mehra, who heads the Ontario Health Coalition.

Home care has long been held up as potential solution to many of the problems plaguing health care in Ontario, including overcrowded hospitals and long waits for long-term care beds.

But the system that provides care to residents in their homes has long been fraught with problems and subject to upheaval by nearly every provincial government in recent decades. It is chronically understaffed and relies on a workforce of mainly personal-support workers who are generally poorly paid.

The Conservative government says its legislation will improve home care by linking it more directly to hospitals and other care providers.

Currently, home care is delivered by agencies: some private and some not-for-profit. It is overseen by coordinators who work through the local health integration system (LHIN), which is being partly dismantled by the provincial government.

The Ontario government says the bill will not increase privatization in the delivery of home care, but CUPE, which represents some of the public-sector workers whose jobs will disappear because of the legislation, disagrees.

Doug Allan, a researcher with CUPE says the bill and its regulations will be used to privatize health care services in several ways by weakening public oversight, creating different home-care structures in different parts of the province, fragmenting home-care oversight, removing legislative protections and requiring another round of home-care restructuring.

He calls it an “untested, experimental leap into a new home care future. Years of restructuring and chaos beckon.”

Mehra, executive director of the Ontario Health Coalition, says the bill is too vague, leaves too much up to regulations which can be changed, crucially dismantles the remaining public governance and control of home care “and proposes to hand it off to provider companies, including for-profit companies, that do not have public governance and accountability.”

She also notes the bill contains no provisions to improve access to care, equity, home-care assessments, quality of care or staffing shortages. Specifically, she said, there is no measure to stop one of the biggest problems plaguing patients who receive home care: missed visits.

Critics say it is particularly worrisome that the bill is being rushed into law while the COVID-19 pandemic in Ontario is continuing and that it doesn’t take into consideration any of the lessons learned from the pandemic, especially when it comes to care of the elderly.

The Ontario Health Coalition is calling for the bill to be repealed. Most of the more than 750,000 people who will be impacted don’t even know that the changes are happening, Mehra said.

“This is poor policy that benefits private interests seeking to increase their market share or their profit margins, but it does not serve the public interest.”

Allan calls the timing of the bill terrible.

“We are still in a state of emergency. This legislation is pre-COVID and the reforms were drafted years before COVID-19.”

The biggest health-related issue facing the provincial government now is the pandemic and preventing a deadly second wave of COVID-19 in long-term care homes, he said. That requires urgent attention to improve staffing levels in long-term care and make sure residents are no longer living in four-person rooms, where preventing spread of infection is difficult, if not impossible.

Allan said the vagueness of the bill could make things worse in health care and lead to less accountability and fewer protections for workers.

“These are the group of workers that are (hailed as) heroes right now,” Allan said. “(The government) is hard at work to try to undermine working conditions and use that to help worsen the bargaining climate for them.”

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