Defend Public Healthcare

The Ontario Liberal government's " Action Plan for Health Care " sought to divert attention from the cuts to hospitals by claiming that it is moving patients from hospital by focusing on building homecare. While many in the media bought this, more careful observers might have noticed that this has been pretty much the same line from government for many years, if not decades. The result has been the elimination of 30,000 hospital beds, backed up Emergency Rooms, ambulance off-load delays,repeated hospital crisis designations, and very high bed occupancy. Oh yeah -- and 10,000 people on homecare waiting lists. Rolling out the Health Action Plan, the government recently (and loudly)  announced 3 million hours of homecare personal support over three years.  (Now it's not very clear if they mean 3 million hours over three years, or building to 3 million hours in the third year, but let's assume the best and say they mean the latter.) Such an increase sound

The Ontario government's system of contracting out for home care services (the so-called "competitive bidding" system) has been put on hold for another two years, it seems.  Following a meeting with government officials, various bosses and mucky-mucks in the Ontario home care industry have come out and   declared  the following:   As proposed in a first step in a phased transition, new contracts would be developed and then negotiated with existing service providers outside of a competitive bidding process, effective October 1 st , 2012 for the subsequent two year period (2014). These new contracts would reflect the realities of our environment; quality imperatives, fiscal restraint, greater focus on client-centred care and defined client populations, and the requirement to collaborate and implement change over a short period of time.    In subsequent phases it is proposed that all home care contracts will be renewed based on clear performance metrics related to t

One interesting line in the Ontario government's new "Action Plan": "In addition to integrating family health care into LHINs, we will introduce further reforms to promote more seamless local integration, with fewer layers of administration, to ensure we have a system truly structured around the complex needs of an aging population." What might "fewer layers of administration" mean?  That is unknown, at least to this writer.  But some have pointed to the oddity of the Ministry of Health and LTC funding the LHINs, the LHINs then funding the CCACs, and the CCACs then funding the contracted home care providers. Especially as the CCACs have been restructured so their boundaries coincide with the LHIN boundaries. Other thoughts?

The Ontario government's Health Care Action Plan, announced yesterday, will mean less public health care. As has been the constant refrain for decades, the official plan is to move patients from hospitals to home care. The idea is that hospitals are expensive and home care is cheap. But the plan does not add up. The home care hours promised - 3 million -- mean spending about an extra $75 million, based on government figures. That's a tiny drop in the bucket of the government's $47,139,590,260 ($47 billion) health care spend: less than 2 tenths of one percent. It may make up for population growth this year. It may even make up for the aging population (this year). But is it going to also reduce the 10,000 person home care wait list, divert people from ending up in long term care facilities, or offset hospital cuts? No way -- it's a pathetically small increase by any standard, never mind by what the government says it is doing. As in the past (w

Nine of the province's 14 Community Care Access Centres (CCACs) are in deficit, the Chatham Daily News reports.  The local Erie St. Clair CCAC has asked for $5.2 million to tide it over this year.  The Local Health Integration Network (LHIN) is only handing over $1.5 million for now and refused its request to let its deficit run over to next year.   Gary Switzer, the LHIN CEO, said the CCAC may end up needing that money, "we just don't have enough data to determine what the real need is." But Betty Kuchta, the CEO of the Erie St. Clair CCAC,  replied that the CCAC may have to put hospital patients looking for home care on waiting lists.  Kuchta said waiting lists mean more frail, elderly people will stay in hospital when they could be cared for at home.   The costs of the province's 'Home First' program, designed to get patients out of hospital, are driving up CCAC costs across the province, it seems.   The 14 LHIN CEOs are meeting in January to

The National Post section "Entrepreneur"  ran a piece yesterday that suggests increasing business interest in Canadian home care.  The article spent some time on two new Canadian "master franchisees" for the America company BrightStar, which has 229 locations in the U SA.  The two Canadian master franchisees are Brian Evans and Jim Jacoboni: Both acknowledge the huge potential in a burgeoning industry that some estimates peg at 18% annual growth.  BrightStar plans to open about 50 franchises in the next three to five years, with 22 in Alberta and British Columbia, and 25 in Eastern Canada to be overseen by Mr. Evans.  " The health care sector demographics are obvious, " Mr Evans says. " The squeeze on provincial budgets is an obvious factor, as well. " Although provincial governments are delivering some  home care  services directly, the private sector is moving quickly to fill in gaps in service and could even be contracted out by governme

The Central East Community Care Access Centre (covering Durham, Northumberland, Peterborough, Haliburton, and Scarborough) reports a drastic decline in the amount of services it provided in its most recent annual report . There was 199,000 fewer "units" of personal support provided than in the previous year. The personal support budget was cut almost $4 million.  Nursing was harder hit. Nursing visits were reduced by 250,000 "units" and  2,000 fewer clients were served.  The visiting nurse budget was cut by over $8 million -- a 19% cut. Physiotherapy service units were cut 28%. Overall, Central East CCAC expenditures were cut almost $12 million, while its revenue actually increased over $7 million. In 2009-10 there was a significant deficit, so these cuts may have been made to make up for CCAC's debt. With no guarantee of home care, the care you receive is driven by budget rather than need.

The head of the Ontario association of for-profit home care corporations, claims , " As a direct result of competition today's home care system is more accountable, has better client service indicators and has greater transparency than it did in the past." Which is news to many of us. Not least because there has not been any real competition in Ontario home care since the Ontario government was forced to suspend the compulsory competitive bidding process years ago, due to complaints from the community. In fact it is now almost seven years since the process was first suspended. So... competition delivers results -- even when there is no competition? It is, however, interesting that the Home Care Association is publicly advocating for the old system: it sounds a bit like they hope to get competitive bidding back once the election is out of the way. If so, the failure of the PCs won't help them, especially if the Liberals fail to get their majority,

Ontario's 14 Community Care Access Centres (CCACs) have come out with a new report just before the provincial election.  They make five recommendations, notably including a plea for their continued existence and a call for better alignment and formalized relationships between public health, primary care, CCACs, and Local Health Integration Networks (LHINs). The call for recognition of the important role of CCACs is hardly surprising: their sister organizations, LHINs, play a somewhat similar role and they have been sharply attacked, with the Progressive Conservatives damning the LHINs as an ineffective and costly layer of government bureaucracy.  Instead the CCACs insist their role in case management provides a vital "neutral broker" in the health care system, and is not simply another layer of administration. The call for better alignment and a formal relationship is hardly relevant to the LHIN--CCAC relationship -- the CCACs were already restructured to align with t

The Sudbury Star reports that Community Care Access Centre clients on crisis lists are given first shot at any long-term care bed that becomes available in their community.  But if they refuse that first bed, they face having home care reduced as the refusal indicates they are not in crisis. MPP France Gelinas, the NDP Health and Long-Term Care critic, says the policy causes untold hardship for people in Ontario. The Star adds that this "policy, or at least the result of it, has devastated the family of Alphonse Savoie, of Hanmer.   The 81-year-old's six children fought to keep Alphonse and his wife, Alice, together as long as they could.   After exhausting the family's financial and emotional resources, and failing to find long-term care together for their parents, the family finally agreed to place Alphonse alone at Extendicare York." Update: The Star reports today that Health Minister Matthews and the Ministry are following up with the North Eas

Yesterday, I noted that the Ontario Hospital Association and the Ontario Association of Community Care Access Centres have now (very mildly) weighed in and noted that some of the alternative level of care  (ALC) patients are, in fact, waiting for "institutional" (i.e. hospital) services, particularly in the area of rehabilitation and complex continuing care. This, of course, is quite true -- more ALC patients are waiting for rehabilitation and complex continuing care  than other sorts of care  (except, of course, for long term care, which has masses of patients waiting for a bed). In fact the backlogs in these two areas represent a fairly high portion of total existing capacity.  About 327 ALC patients are waiting for rehabilitation -- that's equivalent to 14.1% of the total number of rehabilitation beds in the province (2,322).  Another 266 patients are awaiting complex continuing care, equivalent to 4.6% of the total number of complex continuing care beds (5,79

On Tuesday, as part of their health care funding announcement, the Ontario Progressive Conservatives promised  40,000 new and renovated long-term care beds Increasing investments in home care, and giving families more control over services There are exactly zero  promises regarding hospitals.  Given that the PC funding promise is more like a promise to cut services (see yesterday's note),  the emphasis on long term care and home care will likely mean an especially hard time for hospitals.   That is completely consistent with the initial approach of the Mike Harris PC government in the 1990s.  The Harris PCs actually cut hospital funding (not just by letting inflation erode the value of their funding, but by actually reducing the number of dollars provided).   And they did this under a fog of rhetoric about better long term care and better home care.  Eventually, rising public anger forced them to reverse direction and increase hospital funding (quite significantl

Government often talks about home care as a replacement for hospital care.  But with drastic underfunding of home care, the reality falls far short.  Here's an eye-opening two minute video from Operation Maple. dallan@cupe.ca

The health care funding crisis is coming at the Liberal government from every direction lately, even from friendly newspapers.   The Toronto Star  has started a series on home care, showing how patients are falling through the cracks at a time when hospitals are discharging patients “sicker and quicker”. The  Star  found numerous stories of seniors denied access to home care or just given a few paltry hours.  A 90-year-old Scarborough woman with dementia is told she does not qualify for home care. A daughter in Stouffville begs to keep a few home care hours for her 86-year-old father who is paralyzed by a stroke. In Aurora, a woman who cares for her chronically ill husband, was refused home care after she broke her back. The series started Saturday ,  and continued Sunday  with more to come later this week.  Take a peek.  It seems it never rains, it simply pours:  The  Peterborough Examiner also ran a front page story yesterday detailing the trials of getting home care

Comcare, one of Canada's largest for-profit  home care  providers, must pay more than $800,000 toward the lifetime care of a disabled Kitchener girl injured by its care. The child's parents sued Comcare after a former Comcare nurse was convicted of aggravated assault for  abusing  their baby girl, Leandra Knarr, over several months in the spring of 2002. The already handicapped baby was 20 months old when Comcare began to provide overnight care so the couple could sleep. A home videotape showed the nurse punching and slapping the baby in the head and chest, pulling her from her crib by her hair and pushing her hand down on her face as though suffocating her. She  violently  twisted her limbs, resulting in three fractured limbs. Along with Comcare, the parents also sued the  Community Care Access  Centre (CCAC) of Waterloo Region, which contracted with Comcare to provide nursing service.  (CCAC's are required by the provincial government to contract out home care s

While the Ontario government claims that expanded home care services are the answer to hospital cuts, the reality on the ground is a little different. The Hamilton Spectator reports that "patching together services from the CCAC, as well as private home health care agencies, is becoming more the norm as families struggle to help ailing family members stay in the home." "If they don't get enough hours from the CCAC we top them up," Yvonne Griggs chief executive officer of Alert Best Nursing and Home Care Solutions reports.  Families pay almost $24 an hour for a personal support worker who does meal preparations and help clients, who are mostly elderly, with bathing, exercises, and walking. Even Progressive Conservative health critic Christine Elliott says this is creating a two-tier system where those who can afford more services get better care.   "What's happening in Hamilton is indicative of what's happening across the province. CCACs a

The press secretary to Minister of Health Deb Matthews, said Friday the province is planning for a funding increase for the Hamilton Niagara Community Care Access Centre (CCAC) “in the very near future.”  The Hamilton Spectator   reported   just prior to this announcement that the CCAC was cutting home care services to deal with a deficit shaping up to be in the $10 to 12 million range this fiscal year. The government's increase for the CCAC however will only amount to$2.3 million, or 1%.  So the cuts, it seems are going to keep on coming. The increase for homecare (such as it is) is still 1% more than  earlier reports had suggested  -- and we are more than half way through the fiscal year.  But I don't think this announcement quite qualifies as a "step forward". The 1% is reportedly part of the province-wide increase for CCACs.  The (acting) boss of the "Hamilton Niagara Haldimand Brant LHIN" reports that the LHIN has known about the new money for

The Hamilton Niagara Haldimand Brant Community Care Access Centre has run up a $5 million deficit so far this year.  If it doesn't make significant cuts, the shortfall will grow to between $10 million and $12 million by March 31, the end of the fiscal year, according to the Hamilton Spectator . To cut costs, new patients needing more than 60 hours of home care a month will have to stay in hospital on indefinite waiting lists. New home care clients will get only one bath a week unless they are incontinent and those at low risk will face wait lists for services. Other patients will be sent to community nursing clinics for care instead of having home care come to them. Hospitals worry the result will be backlogs, particularly in the emergency department. "It impacts the whole system from end to end," said Mary MacLeod, vice-president of patient services at Burlington's Joseph Brant Memorial Hospital. The Ontario Minister of Health, Deb Matthews has claimed that

Patients who no longer need medical or surgical beds (ALC patients) now occupy about half of the medical and surgical beds at the Lake of the Woods Hospital in Kenora, according to the Miner and News . Despite a rapidly aging population, the provincial government is slowing the development of new nursing home beds across the province. Some new transitional beds are being established in nursing homes, retirement homes, hospitals, and other facilities around the province, but not in sufficient numbers to stop the back up of patients in hospitals.  As a result, high bed occupancy constantly threatens the ability of the hospitals to treat new patients and provide adequate care.  "We've been fortunate that there hasn't been as much (admittance) as we had last fall and winter," said Mark Balcaen, the hospital CEO. "We're coping but at any moment, things could change. All you need is a four or five person surge to be admitted tonight and we're back to the

Yesterday, the Institute for  Clinical Evaluative Sciences (ICES -- funded by the Ontario Ministry of Health and LTC) released a detailed study on seniors health care entitled  Aging in Ontario .  The study reports a number of interesting results: The number of Ontario seniors aged 85 and older increased by 36% over six years (2002-3 through 2008-9), This is more than any other age group in the adult population.  There was also a 13.7% increase in seniors 65 and over. The number of acute care hospital beds per 100,000 Ontario seniors decreased (Quite significantly: from close to 1,000 beds to, perhaps, 850 beds -- D.A.). The number of "ALC patients" (i.e. patients in acute care beds who no longer need acute care services) waiting for a bed at an LTC home (i.e. a nursing home)  almost doubled between 2005/06 and 2008/09. Patients in hospitals waited 55 days in the last quarter of 2008/09 for admittance to an LTC home. Those admitted from the community waited 153 days, w