How the hunt for profits has shaped Ontario’s home care system
Posted: January 20, 2020
(January 17, 2020)
By: Zaid Noorsumar, Rabble.ca
“I’m just sad that I’ve done [care work] for my whole career. My whole career has been taking care of people and trying to uphold a certain standard of care. And to come to this stage, so close to being able to retire and of course, I’m retiring with nothing. I got nothing. There’s no pension plan. And I’m sitting here with a toothache because I don’t have dental coverage, and I’m like, I take my whole life to take care of people. And nobody’s taking care of me.”
Dyana Forshner-Juby, a 58-year-old personal support worker for CarePartners, a for-profit home care company
The value of care work
Dyana Forshner-Juby is a personal support worker (PSW) with over 25 years of experience working in Ontario’s care sector. She works in Belleville for CarePartners, an agency that is contracted by the provincial government to provide home care services.
The work is demanding, unstable and low-paying.
Forshner-Juby and her colleagues often drive long distances to visit patients at home — generally seniors, but also younger people with disabilities. They provide personal care including feeding, showering and toileting people, but are increasingly tasked with responsibilities traditionally handled by nurses.
About 60 per cent of the 3,000 CarePartners workers represented by the Service Employees International Union (SEIU) earn $16.50 per hour. Workers say they often earn less than minimum wage as they don’t get hourly wages when travelling between clients, while still accruing expenses for gas and car maintenance.
Scheduling is unpredictable and unstable. Several back-to-back home visits may be followed by hours of no work — time when workers must be available for their employer but which goes unpaid. As a result, workers tend to pick up shifts during off-hours.
“They will give you five or six hours, sometimes eight,” says Gloria Turney, who works shifts at a local hospital to supplement her income.
“But there are days when they give you one hour, there are days when they give you two.”
Forshner-Juby mentions a colleague who recently had to visit her local food bank.
“She’s got four children and she’s a single mom,” she says. “She couldn’t count on her hours and then her car broke down and that’s pretty much wiped her out. And she had to rent a car so she could continue to work.”
Unsurprisingly, staff turnover is high.
Same funding, different outcomes
Forshner-Juby’s benefits aren’t particularly generous. She has 80 per cent of her medications covered, but no dental coverage. And yet, she shells out about $250 monthly for benefits while the employer contributes $70 a month. At the bargaining table, the SEIU is urging the employer to increase its benefits contributions to $100 to no avail.
CarePartners doesn’t have a pension plan. Based on provincial law, Forshner-Juby is entitled to three weeks paid vacation but her poor compensation compels her to forgo the third week. And although she and her cohorts frequently visit ill patients, her employer is refusing workers paid sick days.
In Hamilton, the Victorian Order of Nurses (VON) is another home care agency contracted by the government to provide services.
Based on the agreement with Ontario Public Services Employees Union (OPSEU) Local 269, VON Hamilton’s full-time personal support workers are eligible for 18 paid sick days, benefits, a defined pension plan, hourly pay encompassing travelling time and up to seven weeks paid vacation.
However, as home care providers contracted by the government, both VON and CarePartners receive approximately $36 of public funds per hour of personal support service provided to clients.
What accounts for this huge disparity in compensation and benefits? The most notable distinction is in their raison d’etre — VON is a charitable organization while CarePartners is a for-profit company.
Based on Statistics Canada data, operating profit margins for Ontario home care companies in 2017 were 7.8 per cent.
The for-profit takeover of the home care industry
Until the early 1990s, most providers in the home care industry in Ontario were non-profits. Agencies such as VON had a long history of catering to seniors and people with disabilities, stretching back to the late 19th century.
The sector was based on a co-operative model, whereby agencies in their quest to improve services shared information, knowledge and resources.
That changed in 1996 when the newly elected Conservative government led by Mike Harris introduced “managed competition,” pitting providers against each other.
The province created 43 Community Care Access Centres (CCACs), Crown agencies that would contract home care services out to providers such as VON. The purported logic was to “create efficiencies” through a competitive bidding process.
But competition in the market comes down to lowering costs, which was in sync with the Conservatives’ “Common Sense Revolution” of reducing government expenditures.
“The whole point of bringing competitive bidding was to open the so-called market to for-profits, and to invite them to go against the non-profits,” says Natalie Mehra, executive director of the advocacy group Ontario Health Coalition.
“The for-profits were able to underbid non-profits by reducing the cost of labour.”
In a 2001 report, the Ontario Health Coalition pointed out the disruptive role of the competitive bidding process. In 1999, VON lost a contract in Windsor to Olsten, a for-profit corporation which had been convicted and fined $61 million for defrauding American Medicare.
As noted in the Centre for Policy Alternatives publication, “Unsafe Practices,” VON’s proposal was costlier by $7 an hour.
Olsten also won a contract in Sault Ste. Marie, despite having a sole staff member in the community.
The funding across CCACs was inequitable, arbitrary and inadequate. Clients with the same assessments were treated differently based on their region — a problem that has persisted ever since.
Services were reduced for seniors and people with disabilities, many of whom had to swallow the bitter pill of losing workers they had formed bonds with.
Due to funding cuts, non-profits that had provided services for decades in some communities closed due to bankruptcy. In Haliburton and Victoria, VON shuttered after 26 years of operations after losing $240,000 in government funding.
The charitable Red Cross closed down in Windsor in 1999 after workers refused to accept a 50 per cent reduction in travel compensation.
But the market had spoken. In 2011, the OHC reported that for-profits were providing 64 per cent of home care personal support services compared to 18 per cent in 1995.
In 2009, in response to protests by unions and advocacy groups, the Liberals imposed a moratorium. The existing contracts were frozen in place and have largely remained unchanged since.
Currently, CarePartners is one of two home care agencies delivering service across all 14 local health units. The company initially operated in partnership with the non-profit Red Cross, before the latter exited the sector.
The CEO of CarePartners, Linda Knight, is also the chair of Home Care Ontario, the association that predominantly represents for-profit providers.
Workers pay the costs of privatization
Lucy Morton, president of OPSEU local 269, has worked as a nurse at VON Hamilton since 1982. Over the past two decades, she has witnessed the deterioration of the home care system.
It used to be a great job back when she first joined, she says.
The job came with respect, security and benefits. But she says privatization and for-profit delivery has negatively affected both workers and patients.
“There’s only two ways to make money,” Morton says. “It’s either off the backs of the workers, or to cut back service on the very people who depend on you.”
Prior to competitive bidding, home care was a more unionized sector. When for-profit corporations began to replace unionized non-profits, workers’ rights were among the first casualties.
As the Conservatives rolled back successor rights (legislated by NDP), when contracts changed hands between employers, workers did not retain their unions.
According to Statistics Canada data from 2018, 31.8 per cent of home care workers in Ontario are unionized.
The for-profits tended to pay “piecework,” had employees on split-shifts, and replaced full-time work with part-time, precarious roles without benefits.
“Working conditions deteriorated and there have been staffing shortages in health care ever since,” Mehra says.
One study honing in on a mid-sized Ontario city, noticed that 52 per cent of nurses and personal support workers left their agency in the five years following the introduction of competitive bidding.
Currently, only 38 per cent of PSWs in home and community care are currently employed full time. According to Home Care Ontario, PSWs provide 74 per cent of the care in the sector.
Falling standards across the sector
Mehra says that for-profit takeover of the industry has shaped the working conditions across the sector even as non-profits retain the ability to compensate better.
“The wages and working conditions are better in non-profits as a general rule than in for-profit [companies],” Mehra says. “[But due to the legacy of competitive bidding] we see the non-profits copy the behavior of for-profits in order to compete.”
This point of view is echoed by Charlene Nero, a regional director for the Laborers’ International Union of North America (LiUNA), which represents about 5,500 health care workers.
Nero says that although LiUNA’s contracts with VON provides members with stable working hours, benefits, pension and sick days, these entitlements are largely given to full-time workers.
“Because they’re competing with the for-profit sector, [non-profits] are constantly constantly engaging in the same activities that the for-profit sector engages in,” Nero says. “So they have to avoid hiring full-time people and hire part-time people [instead].”
Indeed, the working conditions for many non-profits are terrible, especially when they are not unionized.
“There doesn’t seem to be a big difference [based on ownership] at all,” says Debbie Oldfield, organizer for CUPE in Kingston.
“And it’s hard to know because when you interview people and they tell you what their wages are, they may be making more than someone else in the same [organization who’s earning a lower wage].”
According to Deborah Simon, the CEO of Ontario Community Support Association (OCSA), the organization that represents non-profits, agencies struggle with compensating workers due to inadequate funding.
She says this is particularly a challenge in rural communities where workers travel long distances to reach clients.
Simon says better compensation for workers would also help with recruitment and retention, pointing to the PSW shortage.
However, the OCSA’s members are now restricted by the Ford government’s recently passed wage constraint legislation, which restricts publicly funded employers to one per cent wage increases. The legislation exempts for-profit providers.
“We’ve written a letter to Minister of Health [Christine] Elliot, asking for an exemption for our members to not be part of the legislation,” Simon says.
The Ministry of Health, responding to questions over email, cites increased funding for personal support services and improving minimum wage for PSWs in its effort to improve working conditions.
The government’s increased rates for hourly services amount to two per cent over a two-year period for the vast majority of personal support contracts.
Meanwhile, the current PSW minimum wage of $16.50 was enacted by the previous Liberal government, which phased in a $4 raise over three years from 2014 to 2016.
The government’s response was influenced by the 16-day SEIU strike by CarePartners workers in December 2013.
‘I’m retiring with nothing’
Dyana Forshner-Juby spent over a decade working in nursing homes until the late-1990s, before spending a few years in Mozambique and South Africa.
When she returned and decided to work in home care in 2007, she chose the charitable organization, Red Cross, as she was aware of their work in Africa. Over time, the non-profit merged with CarePartners before ultimately exiting the sector.
The job was a lot better before CarePartners came on board, Forshner-Juby says.
Because the Quinte office was among the last ones to merge with CarePartners, Forshner-Juby and her colleagues retained one of the last vestiges of their previous employment contracts — pro-rated hourly wages for travelling time. However, the employer has forcibly removed that basic accommodation.
Forshner-Juby, a member of SEIU’s bargaining committee and a union steward, is determined to fight. It’s not like she has other options.
She has worked her way up within CarePartners to the top of the wage grid. Elsewhere, she will have to start at the bottom.
“I’m just sad that I’ve done [care work] for my whole career. My whole career has been taking care of people and trying to uphold a certain standard of care,” she says, in a voice tinged with exasperation and disappointment.
“And to come to this stage, so close to being able to retire and of course, I’m retiring with nothing. I got nothing. There’s no pension plan. And I’m sitting here with a toothache because I don’t have dental coverage, and I’m like, I take my whole life to take care of people. And nobody’s taking care of me.”
Zaid Noorsumar is rabble’s labour beat reporter for 2019, and is a journalist who has previously contributed to CBC, The Canadian Press, the Toronto Star and Rankandfile.ca. To contact Zaid with story leads, email zaid[at]rabble.ca.