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Public funding for long term care must be redirected to services for seniors

Posted: October 1, 2015

(October 1, 2015)

By: Lloyd Mack, Kenora Miner and News

Two weeks ago, I mentioned my grandmother in a column I penned about Greyhound Canada’s plans to cut the number of scheduled trips along the TransCanada, I’ve been thinking of her again in the wake of a horror-filled report released last week by Ontario’s Auditor General Bonnie Lysyk about the way Ontario looks after home care.

My grandmother was forever my role model of independence and I use her as an example because I remember the importance of home care in maintaining her lifestyle until she was almost 90. It was only after breaking a hip and some other health-related complications that she moved from her own apartment to a nursing home for the last almost six years of her life.

Now, if she had lived in Ontario and the alarm bells were ringing that Ontario’s home care agencies are a mess — depriving patients of much-needed care while fattening the wallets of senior executives and administrators — her family would have been rightfully up in arms.

Lysyk took particular aim at the 14 Community Care Access Centres, the publicly funded organizations that coordinate nursing, therapy and personal support services for patients outside of hospitals.

Among her findings was the stunning revelation that of $2.4 billion funneled to the agencies last year, just 61 per cent was used for face-to-face care. For years, CCAC bosses have being boasting — falsely it turns out — that 92 cents of every dollar went to direct patient care.

There should be no boasting that ill and elderly patients are on waiting lists or deprived of necessary health treatments while CCAC CEOs’ salaries rose an average of 27 per cent between 2009 and 2013, to an average of $249,000 annually — with some top executives earning nearly $300,000 a year. This far outpaces the private and non-profit home care sector.

By contrast, most personal support workers make less than $20,000 a year.

“We found that the service delivery system needs change,” said Lysyk. “Our audit confirmed that the current service delivery model is contributing to varying levels of service across the province.”

Her disturbing overview pointed out that eligibility criteria for complex care patients discharged from hospital vary from one community care access centre to the next, and nearly half the people don’t get treatment within 24 hours of going home as required.

“The CCACs also need to work harder to standardize care so that patients with similar conditions are consistently treated using agreed upon best practices, regardless of where they live,” she said. “Unfortunately, there are no standard care protocols in use throughout the system.”

I can only imagine the frustration with the system and the anger anyone dealing with the bureaucracy must feel when it becomes apparent where the priorities have landed.

Some political fingers were pointed at the then-Conservative government of 20 years ago for creating the CCACs and inviting private companies to bid on services that until then had been provided by non-profit organizations.

“The private sector was going to provide home care better, cheaper, faster than the not-for-profits that had been doing it for decades,” said NDP health critic France Gelinas. “This experiment has failed. Bringing in the for-profit sector brought us a broken health care system.”

That all said, there have been warnings about some of the issues Lysyk raises for years and no one in government has resolved things.

In 2013, an independent accountant, David Williams, said he thought the CCACs were spending only 65 per cent of their budgets on patient care. His estimates were contradicted at the time by then-CEO of the Ontario Association of Community Care Access Centres, Sharon Baker, who insisted that 91.3 cents of each dollar went to patient care.

In response to Lysyk’s report, new association CEO Catherine Brown is defending the money going to administration. She responded that the value of the “time care coordinators spend with patients” is “relatively easy to demonstrate” whereas the value of all the support services performed is slightly more difficult to measure and the definition of care that Lysyk offers in her report is too narrow.

“CCACs provide care, not just treatment,” Brown explained. “The work to assess, consult with other professionals and pull together the right care is an essential, direct component of patient care.”

Earlier this year, the Ontario Health Coalition released a two-study, The Care We Need, and called for a complete overhaul of the home care system. A second report, Bringing Care Home, made public in the spring by a group of experts commissioned by the Ontario government contained 16 recommendations to streamline and integrate services to make it easier for patients and caregivers to navigate a system that is now overly complex and unresponsive. As the experts say, the current home care system simply “fails to meet the needs of clients and families.”

The auditor general will release two more reports on home care in 2015, both to be included in her annual report to be filed likely in early December. One is on the CCAC’s home-care program focusing on personal support services and the other on the performance of the 14 Local Health Integration Networks (LHINs) that oversee and fund CCACs, hospitals and other community health services.

But Hoskins doesn’t need to wait for these reports before acting. The evidence that the home-care system is a mess and that the CCACs are a big reason for that sorry state is overwhelming.

It’s time for Hoskins to appoint a task force with a mandate to propose real reforms that will improve the lives of all Ontario patients who need treatment at home and prepare to accommodate the fast-growing number of Ontarians with Alzheimer’s and related dementia, those people already on wait lists for home care services and the increasing need for home care to help seniors retain their independence.

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