Home care should not be for-profit: NDP's France Gélinas

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France Gélinas. Image: Submitted

rabble spoke with France Gélinas, the NDP's health critic in the Ontario legislature, about the state of home care in the province, the CarePartners-Service Employees International Union (SEIU) dispute and the potential solutions to reverse profit-taking in the sector. 

Update: The interview was conducted on January 20. By January 25, SEIU had reached a deal with CarePartners. 

This interview has been edited for length and clarity.

rabble: What are your thoughts on the ongoing dispute between CarePartners and SEIU?

France Gélinas: It's just awful. This is the second [recent] labour dispute with CarePartners. They locked out their scheduling employees in Sudbury, where I live. Six months later, they closed up shop. What they are doing now with their [other] employees is ruthless. It's not the way quality health care can be done. It's terrible. 

SEIU says that if CarePartners gets away with this conduct, other employers in the sector will potentially emulate their behavior and will end up driving down working conditions across the sector even further. Does the NDP have any ideas on how to confront this employer and address this challenge right now, as opposed to waiting for the next election?

We do. [But] are there realistically things we can do without giving workers false hope? They are more limited.

CarePartners is there to make money on the backs of frail, elderly people and on the backs of women who often don't have a voice. The way they operate has nothing to do with quality care. It has everything to do with maximizing profits.

At NDP we [advocate] for a public health-care system that has to be not only publicly paid [for] but publicly delivered. You have way more control over the behavior of a public not-for-profit organization. 

We have a board of directors that you can go to. They have minutes of meetings that are public.  [There's levers of control], if they start to stray you can bring them back and show them that their reason for being is to provide quality home care. When it is a for-profit company, there are not enough of those levers. 

There's always public shaming, and we had quite a bit of that in Sudbury, but they are totally immune to it. 

What about privately delivered not-for-profit services? I assume that some of the same issues that we have with for-profit delivery also impact non-profit private delivery because they still have duplicate administrations [and management] and like you said we [the public] don't have access to their meeting minutes and other information. 

Yeah. There are a whole lot layers of oversight and accountability [such as the auditor general] that can be used to investigate what's going on [in the public sector]. Once you go into the private sector all of that is gone. 

So how do we reverse this privatization? I assume that it would be very complicated because the industry has been shaped by the existing system which has been in function for about 25 years. 

It would be very difficult. 

Before Mike Harris came into power, Sudbury [for example] had a top notch home care system. It was delivered by VON [a non-profit provider]. When competitive bidding came in, the services moved to [for-profit firm] Bayshore, who said that they were going to do things better, cheaper and faster.

VON had to declare bankruptcy in Sudbury. All of their staff had to be re-hired. A lot of their staff were career people working in home care -- they were really, really good at what they did. 

Employers who cannot recruit or retain a stable workforce, keep sending different people to peoples' homes and a whole bunch of problems arise from this. You know, grandpa doesn't like to strip naked in front of 20 different strangers every month because there's a different PSW [personal support worker] at his door every time to give him his bath.

This is what we have now, it's terrible. Our home care system is broken on so many fronts [unlike] when we had not-for-profits such as VON and others delivering home care. They were there for the right reasons -- to provide quality care and now most of them are there to maximize profits.

We often hear of home care as the future of health care in this province. And one of the reasons why governments have favoured home care is that it is less costly. But how much of this cost effectiveness is due to poor compensation for workers and the expectation that family members will provide care?

Home care has always been the cheaper option even before Mike Harris opened it up to the [for-profit] private sector. If you go to Manitoba, who never privatized their home care sector, it is still way cheaper to keep people at home than it is to keep them at long-term care homes or a hospital. 

You have to realize that we as taxpayers, we still pay good money for [home care] services. The problem is that this money never makes it to the actual home care workers. There are many levels who take their share of the money and the workers earn $16.50 an hour [the PSW minimum wage in the home care sector].

In other provinces that have not been privatized, the home care system system is cheaper and the workers have full-time jobs with pension plans and benefits. 

What concrete actions could an NDP government take to address some of these issues and transform the sector so that it's publicly-run and delivered?

Is this something we can do overnight? No. But the government has many resources at its disposal to influence the sector. You can mandate minimum wage for different levels of care and different levels of service. 

You can also mandate how much profit can be taken out [when signing a contract with providers]. The government can ask to see the financial report to see how much profit has been taken out of the system. 

You can make the sector attractive to not-for-profit providers. There are many things a government can do and put the focus on quality of care and satisfaction of patients. 

Right now, how many home care patients are satisfied with the services they get? If you listen to my answering machine every morning, we get complaints about home care every single day. 

So from your response, it seems like we can improve the sector by taking certain measures like improving minimum wage and having more transparency. But it seems that to transform the sector from private to public, that can't even happen in say, the next 10 years.

I won't say 10 years. With this government in place, it won't happen. With an NDP government, could it happen? I'd say we can reshape a big part of the sector. If you make it less profitable, the for-profits tend to go away. 

Right now, if you open up a new contract, they fight among themselves over a new contract because there's a lot of money to be made. They don't share best practices, because they use it as a competitive advantage to win the next bid.

You don't see this in any other part of the health-care system. In other parts of the health-care system, once you have identified the best practice you share it so that will help your system progress together. Not in home care, where there are trade secrets to secure more contracts. 

The base funding per hour of personal support services is $35.83 for about 80 per cent of contracts. Providers, both for-profit and not-for-profit say, this is not enough money. Do you agree with that? And if so, how much of an increase should we see in base funding?

The Ontario Community Support Association has put together quite a bit of information regarding that. We are looking at $210 million or so just to increase volume. We are looking at improving PSW wages by at least five per cent per year for the next many years before we can close the gap between what a PSW makes in home care versus how much she -- they are mostly women -- makes in long-term care or hospitals. 

You're talking about hundreds of millions of dollars to stabilize the system, to get rid of the waitlist, where we all know you may qualify for two baths a week, but it won't start for eight months. 

We're talking hundreds of millions of dollars invested in the system to improve base funding [for hourly contracts], to close the wage gap, to increase the level of service and to make the basket of services available for all.

Note: The OCSA's submission for the 2020 budget calls for heavy investment in the home and community care sector

What should be covered under publicly funded home care [so that people are not forced to purchase services from the private market]?

There are many things that would life easier. In Northern Ontario, shoveling snow. We just got a lot of snow right now and there is no way an 85 or 90-year-old could have gone through the dump of snow we got over the weekend. 

I would have liked a bit of support for them to stay at home, like shoveling the snow or cutting the grass. Would I want a bit of support [for them to do home maintenance] so that it is safe for them to do so? Yes, absolutely. 

[Would I like] to have somebody do the grocery shopping for you and prepare a little bit of food and check on your medication? I would like all of this to be covered in order for people to be safe.

[Although] I draw the line -- you will still pay your own rent, still pay for your own food, still pay for your own hydro bills, it's the care that will be covered, not [the expenses] of living at home. 

Zaid Noorsumar is rabble's labour beat reporter for 2019, and is a journalist who has previously contributed to CBC, The Canadian Press, the Toronto Star and Rankandfile.ca. To contact Zaid with story leads, email zaid[at]rabble.ca.

Image: Submitted
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