Defend Public Healthcare

The Financial Accountability Office has released the Ford PC government's funding plans for the various health care sub-sectors .   The news is not good.   The funding plans for 2022/3 in several key line items are down compared to actual funding in 2021/2 :  Funding plans for long-term care services are down $26 million – or down 0.4% compared to last year's actual funding.  Overall funding to the Ministry of Long-Term Care (LTC service funding plus LTC Capital and Development funding) is down $315 million, with the LTC Capital line item down a full $376 million. The LTC Development line item was also completely unspent over the last five quarters. These are mysterious changes when there is a 38,000 person LTC wait list, a desperate shortage of LTC facilities that meet modern design standards, new legislation that forces hospital patients to move into LTC facilities they did not choose, and frequent claims by the government that it is quickly building new...

Cascading health care cuts are resulting in significant problems for home care patients and their families, seriously undermining the main defense the government makes for its policy of hospital and long-term care cutbacks.  With hospital cutbacks and a virtual freeze on long-term care beds, home care and unpaid caregivers must now take care of sicker and sicker patients. This change in home care has been sudden and dramatic, as demonstrated in the graph below  from the the Ontario Association of Community Care Access Centres (the OACCAC represents the public sector organizations which manage home care for the government).   The OACCAC suggests  this shift means home care now replaces 150 long-term care homes, each with a capacity of 130 residents.  The OACCAC estimates cost pressures of about 5% per year to offset demographic changes and for the absorption of patients that would otherwise have been treated in hospitals or long-term care.  The O...

Funding increase hits new low: The Ontario government plans health sector spending growth of 1.2% this year compared with the interim spending estimate for 2014/15.   This deepens the trend to cut health care funding increases. ($000s) 2005-6 2006-7 2007-8 2008-9 2009-10 2010-11 2011-12 2012–13 Actual 2013–14 Interim 2014–15 Plan 2015–16 Health and Long-Term Care 32,947 35,655 38,118 40,734 43,054 44,414 46,491 47,571 48,933 50,173 50,771 % Increase 4.0% 8.2% 6.9% 6.9% 5.7% 3.2% 4.7% 2.3% 2.9% 2.5% 1.2% The average increase over the last four years is 2.2%.  Over the previous six years, funding increases averaged 5.9%, well more than double the more recent average.  This year's plan of 1.2% is a new low.  In 2011, the then Auditor General noted...

The government is coordinating cascading efforts to move patients from organizations where more care is provided to where less care is provided.   For hospitals, government funding models and directives have long focused on removing less ill patients.  In long term care homes, the government quietly raised the criteria for eligibility for the waiting list. They also stopped providing the 'case mix measure' which was the key measure of the increasing illness and acuity of long term care residents. Regardless it is now obvious acuity in the homes is rising rapidly. But these restrictions on eligibility to hospital and long term care homes have also dramatically increased demand for home care services provided by Community Care Access Centres (CCACs).  CCACs are facing both more demand and much more ill patients.  The CCACs claim  the number of their high care need patients have increased 73% between 2009/10 and 2013/14. As a percentage of total pa...

Ontario hospitals report a significant decline in the number of patients in hospital beds who are waiting for a long term care bed.  This has been the main category of the so-called "hospital bed blocker" -- the Alternative Level of Care (ALC) hospital patient -- so it is a significant change.  From November 2009 to March 2013, the number of patients waiting for LTC was reduced by 1,282 patients, an astonishing decline of 41%. This sounds like a victory for better management, but the real story appears to be more complex. This has not happened because a decline in the relevant population. As noted earlier , the 85 and older population is growing  very quickly. Instead, this coincides with a decline in the number of people (at home and in the hospitals) on long-term care waiting lists of 5,000.  As of 2012, we are down to only 32,000 people in total waiting for a long-term care bed, according to the Auditor General . Both of these reductions in wait lists...

The Ontario government likes to suggest that the planned annual 4% nominal increase in "home and community care" funding will offset their cuts to hospital services and squeeze on long term care beds. But it's not totally clear that this funding will offset cost pressures on home and community care arising from the rapid growth in the elder population -- never mind growth in the entire population,  never mind inflation, never mind unmet home care needs, never mind hospital cuts, never mind the squeeze on long term care beds. The Ontario Ministry of Finance estimates that those aged 85 and over will increase 18.8% in the four years from 2012 to 2016. That equals a 4.4% annual average increase. The 90 and over portion of that group will increase much more: 35.1%. That's almost 8% per year. This is relevant to the cost pressures on home care as this age group requires an awful  lot of home care. A December 2012 Statistics Canada report indicates that 54...

The government's new senior's "action plan" discussed in the last post follows on from Dr. Samir K. Sinha’s report   for the government “Living Longer Living Well”.  Sinha's report is labelled only as “Highlights and Key Recommendations”.   A “ full report will present considerably more detailed findings and recommendations that will enable the government to expand upon and provide some specific means of implementing the themes and recommendations set out in this Highlights and Key Recommendations document.” So there may be more to come.   The "Highlights" report makes numerous recommendations in 13 areas.  Indeed the recommendations are stated in a distinctly vague way.  Moreover, they generally follow the well tread path in existing government policy.    Despite some recognition that the elderly population is growing very rapidly,  there is no recommendation for expanded LTC or hospital services and no call for new funding.  ...

Health care privatization continues to come to Ontario via the Liberal government's version of "community care."  Most obviously this comes by moving services from public hospitals to poorly regulated and for-profit retirement  homes.   That has been a repeated theme in the Liberal government's version of community care. Alex E. Proimos Another mainstay is moving services to for-profit "home care" providers.  Except, now for-profit home care is often for-profit clinical care.     Typically, the Liberal line is we need to move services and clinics out of public hospitals and into the home.   But now the government organizations that oversee home care (Community Care Access Centres  or CCACs) are beginning to celebrate moving services out of the home and back into clinics.  But this time the clinics are run by for-profit corporations, not public hospitals.   In a recent news story sparked by the opening of a ne...

Another home care funding announcement came out today, this time for Mississauga-Halton. Mississauga The news this time was a little better, with a 4.1% funding increase for home care via $5.12 million for the Mississauga-Halton Community Care Access Centre.   That is a bit better than the Hamilton-Niagara area, which received 3.25%, and the Ottawa area, which received 3.74%.  This is the first CCAC to actually get the 4% funding increase suggested by the provincial government.

The announcements of new "home and community care" funding (which started last week) continue, this time for the Ottawa area. Home care activists First the good news.  The $7.15 million announced for the Community Care Access Centre (CCAC) amounts to 3.74% increase over the CCAC budget set out in 2011-12 Champlain LHIN performance agreement . The Hamilton-Niagara CCAC increase announced last week was 3.25% .   So this is a little higher, albeit short of the 4% home and community care funding increase promised by the government. Moreover, the overall announced increase of $11.1 million falls well short of the 4% increase for home and community care announced by the government.  If you add together all the items in 2011-12 Champlain LHIN accountability agreement that easily fit in to “community and home care” (i.e. the CCAC, Community Support Services, Assisted Living Services, Community Health Centre, and Community Mental Health line items), the total is ...

The Minister of Health and LTC has finally (7  months into the year) gotten around to making an announcement about the increase to home care funding for this year, at least for the Hamilton Niagara Community Care Access Centre (CCACs fund home care providers). Aside from the long delay, the matter was kept in confusion this year  because the government choose to talk only about "community" services funding, rather than CCAC funding.  No one knew what they were talking about, exactly.  Which may have suited the government just fine. The government had talked about a 4% increase for community services -- whatever they are.  But with this announcement the Hamilton Niagara CCAC is only getting a 3.25% increase -- $8 million on a 2011-12 budget of $246 million . That falls short of what is needed to offset normal home care cost pressures (inflation, aging population, growing use of home care) much less deal with all the other things the government says it is go...

No surprise here -- but the bosses of the for-profit corporations that provide long term care and home care services funded by the public sector are excluded from the Protecting Public Services  legislation proposed today by the Liberal government (as set out in schedule 1 of the Public Sector Compensation Restraint Act, 2012 ) . Also no surprise -- the unionized employees who work  for those bosses at for-profit long-term care and home care businesses don't get any such exclusion (as set out in schedule 1 of the  Respecting Collective Bargaining Act [Public Sector], 2012 ) . They, like other publicly funded workers, are free only to agree to terms and conditions pre-determined by government.

The head of the Erie St. Clair Community Care Access Centre (CCAC) is seeking $4.68 million in new funding to help her agency deal with an $8 to $10 million deficit, the Sarnia Observer reports. CUPE  Local 4370 president Brian Biggers told the Observer that worker hours have been reduced. " It's having a sort of revolving door effect on staff, " he said. " Because staff have to move on to other things. They have to survive. " The CCAC has asked the Chatham Kent hospit al to limit its referrals to the CCAC because of the CCAC's budget deficit. The Ministry of Health and LTC claims that improvements in home care will offset the budget squeeze on hospital services. However, the Observer reports a doubling of in-patients at the local Sarnia hospital waiting for less intensive forms of  health care. Meanwhile the Chatham-Kent hospital is planning to cut over 20 beds. The government agency responsible for funding the CCAC was unavailable for comme...