Ontario’s new home and community care legislation will likely become law by the end of the month with virtually no public consultation, even as it impacts over 700,000 annual care recipients who require personal support services, nursing care, physiotherapy and other services.
Instead of addressing the myriad problems that have plagued the system for decades, Bill 175, Connecting People to Home and Community Care Act 2020, will further move away from accountability, democracy and equity, for clients, family members and workers alike.
I spoke with Natalie Mehra, the executive director of the advocacy group Ontario Health Coalition for her thoughts on the new legislation, the history of home care in Ontario, and the solutions we need.
The problems with outsourcing
Ontario currently outsources nearly all home care services. The fourteen Local Health Integration Networks (LHINs) across the province have agreements with a vast array of for-profit and non-profit agencies.
Mehra doesn’t believe in the contracting-out model. Instead she advocates for public, not-for-profit home care that is accountable to local communities through elected representatives – unlike the government’s appointees in charge of the LHINs.
“The benefit of having a single public system is one that you can have public governance and you can have clear standards,” she says.
In 2015, the Ontario Auditor General reported that home care was contracted out to 160 private for-profit and non-profit agencies.
The Auditor General noted that this fragmented system created bureaucratic duplication as “administrative and overhead expenses are incurred multiple times at each organization.” Combined with profit-taking, this resulted in only 72 per cent of public funds being allocated to frontline care.
The Ontario Health Coalition says that it would be more efficient for the government to provide these services directly, as the elimination of profits combined with a single layer of administration would ensure more money for frontline services.
In 2017, the Liberal government eliminated a layer of administration by dissolving Community Care Access Centres (CCACs), but continued to contract services. The Liberals’ minor reforms also didn’t address the lack of democratic governance of LHINs or the problem of rampant privatization.
“The elimination of the CCACs eliminated a tier of governance,” Mehra says. “The LHINs have fundamental problems. They had a mandate that did not require them to measure and meet population needs for care and that is the fundamental job of a public health care system.”
While the Ford government unceremoniously fired several LHIN executives last November in typical bombastic fashion, the Progressive Conservatives’ new legislation hands over home care governance to agencies that have a vested interest in expanding or maintaining their own market share.
“[The new legislation] basically just hands home care over to the providers, which are dominated by chain for-profit companies and non-profit chains to do as they choose,” Mehra says. “And that is just completely unacceptable and wrong.”
Reforms long overdue
The Health Coalition played a major role in influencing policy when the NDP government undertook home care reform in the early 1990s. In 1994, the NDP legislated a public, not-for-profit system that had minimal provisions for contracting out.
“The Health Coalition was instrumental in creating that model and building a consensus around the approach,” Mehra says. “It was adopted by the NDP and it took a long time and a lot of consultation to come to that.”
However, the NDP plan was never implemented and then the Mike Harris Progressive Conservatives restructured the sector in the interests of health care businesses who continue to profit to this day. At the same time, the budget cuts of the Harris government sent the entire system into a shock from which it has never recovered.
About 25 years later, a new Progressive Conservative government is once again promising major reforms, by tying new home care legislation to its draconian 2019 health care reform bill.
Mehra points out that these changes won’t address missed client visits, poor working conditions, rationing of services and other problems.
The Health Coalition is demanding that the government launch real, meaningful public consultation that takes into account the needs of Ontarians who require home care.
The Heath Coalition says the process should be premised on the principle of public, non-profit governance and delivery, not predicated on the belief that health care of vulnerable citizens should be another avenue for wealth accumulation.