(October 1, 2015)<\/p>\n
By: Lloyd Mack, Kenora Miner and News<\/p>\n
Two weeks ago, I mentioned my grandmother in a column I penned about Greyhound Canada\u2019s plans to cut the number of scheduled trips along the TransCanada, I\u2019ve been thinking of her again in the wake of a horror-filled report released last week by Ontario\u2019s Auditor General Bonnie Lysyk about the way Ontario looks after home care.<\/p>\n
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.<\/p>\n
Now, if she had lived in Ontario and the alarm bells were ringing that Ontario\u2019s home care agencies are a mess \u2014 depriving patients of much-needed care while fattening the wallets of senior executives and administrators \u2014 her family would have been rightfully up in arms.<\/p>\n
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.<\/p>\n
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 \u2014 falsely it turns out \u2014 that 92 cents of every dollar went to direct patient care.<\/p>\n
There should be no boasting that ill and elderly patients are on waiting lists or deprived of necessary health treatments while CCAC CEOs\u2019 salaries rose an average of 27 per cent between 2009 and 2013, to an average of $249,000 annually \u2014 with some top executives earning nearly $300,000 a year. This far outpaces the private and non-profit home care sector.<\/p>\n
By contrast, most personal support workers make less than $20,000 a year.<\/p>\n
\u201cWe found that the service delivery system needs change,\u201d said Lysyk. \u201cOur audit confirmed that the current service delivery model is contributing to varying levels of service across the province.\u201d<\/p>\n
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\u2019t get treatment within 24 hours of going home as required.<\/p>\n
\u201cThe 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,\u201d she said. \u201cUnfortunately, there are no standard care protocols in use throughout the system.\u201d<\/p>\n
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.<\/p>\n
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.<\/p>\n
\u201cThe private sector was going to provide home care better, cheaper, faster than the not-for-profits that had been doing it for decades,\u201d said NDP health critic France Gelinas. \u201cThis experiment has failed. Bringing in the for-profit sector brought us a broken health care system.\u201d<\/p>\n
That all said, there have been warnings about some of the issues Lysyk raises for years and no one in government has resolved things.<\/p>\n
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.<\/p>\n
In response to Lysyk\u2019s report, new association CEO Catherine Brown is defending the money going to administration. She responded that the value of the \u201ctime care coordinators spend with patients\u201d is \u201crelatively easy to demonstrate\u201d 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.<\/p>\n
\u201cCCACs provide care, not just treatment,\u201d Brown explained. \u201cThe work to assess, consult with other professionals and pull together the right care is an essential, direct component of patient care.\u201d<\/p>\n
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 \u201cfails to meet the needs of clients and families.\u201d<\/p>\n
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\u2019s 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.<\/p>\n
But Hoskins doesn\u2019t 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.<\/p>\n
It\u2019s 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\u2019s 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.<\/p>\n