The proposed reforms through Bill 175 will privatize health care services, weaken public oversight, remove legislative protections, undermine home care working conditions, and unleash an untested, home care experiment. Chaos beckons.
Bill 175 is permissive, allowing a laissez-faire framework for home and community care. It repeals the more detailed Home Care and Community Services Act, 1994 and leaves most details to policy or regulation. Deviously, the government has made the Bill (Connecting People to Home and Community Care Act, 2020) little more than an empty shell that doesn't even establish a new home and community act.
So, for example, the Home Care Bill of Rights is not in the proposed legislation. Instead, it may be put into regulation. This approach removes the public accountability that comes with legislation. Regulations and policies are changed with little public consultation. One would think that in today’s world a Home Care Bill of Rights would not be removed from legislation. But that is what this Bill proposes.
Under this reform, the ministries of health and long-term care will fund Ontario Health. Ontario Health will fund Ontario Health Teams (OHTs) and Health Service Providers (HSPs). OHTs and HSPs will contract for home care. Home care providers will employ home care workers and take over Local Health Integration Network (LHIN) care coordination functions.
This convoluted model creates an obvious conflict of interest. Home care providers will deliver the service and provide care coordination, e.g. determine the amount of service. It’s like putting the Colonel in charge of the chickens.
Compounding this, home care providers are often for-profit corporations and will focus first on making a profit rather than patients needs.
The government’s plan to kill-off the LHINs means that the home and community care services directly provided by LHINs (as they are in a small minority of cases) are also under threat of privatization.
Aside from these two forms of home care privatization, the reforms proposed would also privatize hospital services in three ways.
Private, for-profit hospitals have been frozen for years – but this Bill would modify the Private Hospital Act to allow them to expand “home and community care” beds.
Similarly, the ministry is proposing to add unlicensed “residential congregate care settings” as a location for “home and community care services” – with no restrictions on for-profit operators. Instead of public hospitals, these unlicensed congregate care homes would provide rehabilitative, transitional, or other care. We have learned from the COVID-19, however, that inadequate congregate care is a fatal danger for vulnerable populations. Instead of introducing new, lower levels of care, we need to develop and strengthen our best public health care.
Privatization will also come with proposed regulations allowing the home care corporations to operate within hospitals. Multiple chains of command within hospitals are a recipe for miscommunication and error. Home care workers moving from one hospital to the next will also be an excellent vector for the spread of infection.
Deepening past mistakes: Destroying the main public sector organizations in home care (LHINs) completes the privatization of home care begun under the last PC government in the late 1990s.
However, problems followed that privatization of home care delivery. Government was forced to impose moratoriums on competitive bidding. To deal with the appalling, largely privatized working conditions in the sector, government had to directly intervene twice to improve wages.
Trying everything but a public sector model, CCACs were first taken over by the province, then cut from 43 to 14, and later folded directly into the LHINs. This new restructuring completely blows-up those earlier reforms.
Each of these successive rounds of restructuring was sold as a major step forward – just like Bill 175. The reality was that the privatization was a complete failure that led to successive crises in home care. Deepening privatization now will only make matters worse.
The wrong bill at the wrong time: Unfortunately, the government is pushing this Bill forward even as the province is under emergency orders.
We find the timing completely inappropriate. The COVID-19 outbreak has exposed major shortcomings in our health care system. Thousands of LTC staff and residents have been infected, over 1,800 LTC residents and workers have died, and we are not through this crisis yet.
There is an urgent need for health care reform – but that has nothing to do with this Bill. Instead, the focus should be on stopping a second peak of COVID-19, especially in long-term care. This would mean ensuring residents in long-term care are treated in hospitals and not left to die untreated and unquarantined in under-staffed and over-crowded LTC facilities. It would mean increasing pay for workers to attract and retain staff. It would mean increasing full-time work. It would mean weekly testing. It would mean phasing out for-profit LTC. It would mean increasing the time to care.
It would not mean setting off on an unrelated privatization of hospital and home care.
Right now, 14 LHINs contract for home care services within their boundaries. Under the new model contracting will be turned over to 50, 70, 90, or more OHTs, HSPs, and primary care organizations. The new boundaries will be much smaller than the current LHIN boundaries. Home care providers will simply have to adjust their services – and home care workers will too. More restructuring and tumult is on the way for home care providers.
The negative impact on LHIN workers: Even as the government moves to wind-up LHINs, to date we have no assurances about the security of LHIN home and community care workers beyond the immediate period ahead.
A “gradual and phased transition” suggests that the LHIN work will disappear piece by piece from under the feet of the LHIN workers, even as they continue to provide dedicated care to the public.
Supervisors and labour relations: The Bill introduces heavy handed amendments to the Continuing Care Act concerning sale of business and related employer provisions when a supervisor is appointed (as occasionally happens when a hospital falls into some trouble).
Removal of this section (and the rest of the Bill) would be best. But the amendment could also be changed so that the appointment of a supervisor alone shall not indicate that a sale of business or related employer argument can be made. This way, sale of business and related employer provisions would still apply if changes are made that normally would bring those provisions into play.
Conclusion: The government plans to move LHIN work to an unknown number of different organizations, creating chaos and employment insecurity for LHIN workers. In effect the government is hoping LHIN workers will continue to provide excellent service even as their work is being taken away, with no promises of continued employment, much less fair working conditions. Their plans also threaten privatization, conflicts of interest, restructuring of home care delivery, lower wages, weak government oversight, and drastically weakened legislative oversight.
All of this for an untested experiment that offers no solutions to the obvious problems: for-profit delivery, rising demand, inadequate services levels, weak continuity of care, missed visits, and unfavourable working conditions.
This Bill should be withdrawn. The full CUPE Ontario / OCHU brief on these proposed reforms can be found by clicking here.