Home care is not included under the Canada Health Act making it a publicly funded service – but not a publicly insured service. That means you don’t use your OHIP card to pay for it. Instead, the provincial government uses tax dollars to pay private for-profit home care agencies contracted to perform a variety of services.
In Ontario, publicly-funded home care falls under the jurisdiction of the Ministry of Health and Long-Term Care (MOHLTC) and has always been delivered privately but never to this degree.
The services, including nursing, homemaking, therapy, medial equipment, and supplies, were provided through the Home Care Program (HCP). Most of the programs were administered by Public Health Departments in regional municipalities with the remainder administered by public hospitals and the Victorian Order of Nurses.
In 1993, the NDP proposed the Multi Service Agencies model that would have given users of the system a chance for more input. However, that model was unpopular because it was thought that it would erode the volunteer base charitable organizations depend on. In other words, it would have paid people for their labour instead of relying on free labour.
In 1996, the Harris Conservatives introduced the competitive process that was managed by 42 Community Care Access Centres (CCAC). Today, CCAC number 14 and are accountable to Home and Community Care Support Services (HCCSS) – formerly known as Local Health Integration Networks (LHINS).
Publicly funded home care agencies receive referrals through HCCSS who are responsible for determining eligibility and access to government-funded home and community services as well as long-term care homes.
In addition to receiving millions in cash and shares for serving as Chair of the Board for Chartwell Retirement Residences since 2004, Mike Harris and his third wife, Laura, started the for-profit home-care franchise, Nurse-Next-Door, in 2012.
In July 2020, Bill 175, Connecting People to Home and Community Care Act, received Royal Assent. That bill changed who is responsible for administering home and community care.
But Bill 175 fails to distinguish between disabled folk and other clients receiving home-care and community-care. Instead, the act refers to all clients as patients creating a medical approach to services without client input.
The Ford government maintains the bill makes it easier for people to connect with care providers and access care. However, transferring the planning, coordinating, and delivery of home and community care services to Ontario Health Teams could lead to fragmented, inequitable services as well as inconsistent assessments that lead to inadequate care. This bill will ultimately usher in the privatization of last remnants of the home care.
Peter Groves, a member of Hamilton Health Coalition, shares these concerns and his decades long experience with home-care validates those fears.
Groves and his wife, Linda, live in a wheelchair accessible townhouse on the West Mountain. Born with cerebral palsy compounded by scoliosis and severe osteoporosis, Linda has used a wheelchair for the past 40 years.
Linda is now fully dependent on Groves for help with her daily activities. The couple also rely on the assistance of two personal support workers (PSWs) and an electric patient lift to get Linda out of bed and into her chair in the morning and then, the reverse process at night.
At one point, Groves had an issue with the private for-profit home care company he had been dealing with since 1996. He says the PSWs were great but some of those sent to fill in when an assigned worker was sick or on holiday have said, “I didn’t know your wife was in a wheelchair. If I knew that I wouldn’t have come.” Groves feels many PSWs don’t like the physical aspects of the job.
He also believes there’s a lack of standardized training to ensure a uniform standard of care across the province.
While Groves acknowledges the Ford government has promised to train up to 8,200 PSWs through its accelerated college program, he believes fast tracking will negatively impact student learning and undermine their overall level of skill. That, in turn, will affect client experiences.
Groves deals with two private companies – each of whom send one worker per shift – but the companies don’t communicate with each other.
Their services are paid under the HCCSS, however if these companies are not fulfilling their contractual obligations, the HCCSS has no capacity for enforcement.
Some PSWs are being pulled out of home care and reassigned to long-term care (LTC) by management compounding staffing and client issues within the home care system.
For insurance purposes, Groves’ wife requires two workers each visit because moving Linda between her bed and wheelchair requires the use of an electric lift.
There have been several evenings when Groves has had to step up and be that second person, but his own health issues are making it increasingly difficult for him to assist the PSW. That means Linda doesn’t get her full evening routine.
Only one of the companies provides PSWs with Groves’ phone number to let him know if they’re going to be late. When workers from the other company don’t show up, Groves will contact the main office but they usually have no idea where the worker is or if they’re going to show.
Groves has been told to find a family member or neighbour willing to help with Linda’s care, but the 65-year-old maintains, “Medical issues are a personal, private thing and no body’s business.”
Groves also points out that workers know how to do what they are taught in school, but they haven’t learned how to adapt routines to the specific needs each client.
Groves’ wife is extremely sensitive to movement and touch – both can cause her significant discomfort and pain. “Many workers over the years have said, if you’re doing it right there’s no reason to hurt her,” shared Groves. He finds some workers have limited empathy and are in need of sensitivity training.
Part of the problem may lie in the fact that PSWs are not paid for mileage or travel time and clients are book back-to-back. That means PSWs often feel pressured to rush or cut corners in order to meet a demanding schedule.
That has left Groves finishing his wife’s routine once the PSWs have moved to her chair or bed because the PSWs had to get to their next client.
“The system Doug Ford is implementing isn’t working. A lot of home care is being privatized. When not-for-profit contracts are up for renewal, more and more are not being renewed,” observed Groves.
Private companies are more costly to the public system and if the Ford government were to start charging user fees for home care, that would be a financial burden Groves and his wife would not be able to budget for.
“My wife and I are both on OAS [Old Age Security] and GAINS [Guaranteed Annual Income System payments] so we’d be lost,” shared Groves.
He added, ‘We have to get enough people stepping forward saying the system isn’t working. Doug Ford, you’re making it worse, not better.”
Ontario Health Coalition is holding a citizens’ referendum to stop the privatization of hospital services. Everyone 16 years-of-age and over can Vote Online or in person at polling stations across the province on May 26 and 27.
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