Home-care services can’t keep up, audit finds
TheStar.com – News/Ontario/healthzone.ca
December 6, 2010 . Moira Welsh And Theresa Boyle, Staff Reporters
Janet Tapping is trained as a chartered accountant but now she’s giving speech therapy to her 7-year-old son because he’s spent more than a year on Ontario’s home care waiting list.
“I am not a professional speech therapist — I’m hoping the sounds coming out of his mouth are the right sounds,” Tapping said.
“My options were to pay for a regular speech therapist, which I can’t afford, or stay on the waiting list.”
Tapping’s son, Jonathan, is one of the 10,000 Ontarians who are on waiting lists for home-care services, according to a report released Monday by the provincial auditor general.
While Jonathan has been on the Central Community Care Access Centre (CCAC) list since October 2009, many across the province, from young children to the very old, wait an average of eight to 262 days, the report said.
Auditor General Jim McCarter devoted a chapter of his annual report to home care, finding that the sector is unable to keep up with obligations in providing personal support, homemaking and therapy services.
The sector doesn’t have the financial resources to meet the demand for personal support and homemaking services, the report noted. These services are often required by seniors and people discharged from hospital.
And a shortage of professionals in occupational therapy, physiotherapy and speech-language therapy is resulting in waiting lists for their services.
Ontario’s 14 community care access centres are responsible for providing home-care services to more than half a million people who might otherwise have to stay in hospitals or go to long-term care facilities.
McCarter found significant disparities with the provision of home-care services across the province. His report noted, for example, that one CCAC received twice as much funding per capita than another. (The report did not identify the location of these CCACs.)
“The Ministry of Health and Long-Term Care recognizes that enhancing home-care services saves money and improves quality of life by allowing people to remain in their homes rather than in hospitals or long-term care facilities,” he said.
“However, although home-care funding has increased, funding inequities we’ve noted in previous audits remain because the ministry is still allocating fundings based largely on what it gave in the past rather than on the specific needs of the local clientele,” he added.
Natalie Mehra, of the Ontario Health Coalition, applauded the report, saying it “gives numbers to support what many people across Ontario have been saying.
“Home-care services are inequitable and many patients who need them don’t receive them when they get out of the hospital . . . This is a service gap that the government ignores at its peril.”
Sharleen Stewart, president of Service Employees International Union, which represents most unionized home-care workers, called the auditor’s findings the “tip of the iceberg in the crisis that is about to hit us.”
Stewart said the CCACs are not doing proper assessments of clients’ needs, so many personal support workers are giving care that is beyond their training.
“The government has to step in to fix this,” she said.
McCarter was critical of the ministry for taking so long to overhaul the way it funds the sector, noting that the same problem was highlighted in his office’s annual reports in 2004 and 1998.
CCACs received $1.76 billion for the year ending March 31, 2009, up from $1.22 billion in 2004, for an increase of 40 per cent. But since that time the number of clients has increased by more than two thirds, to 586,400 from 350,000.
The auditor also found that eligibility criteria for services differed from CCAC to CCAC. For example, in one, only those clients who were assessed to have “high risks/needs” were eligible for personal support services such as bathing, changing clothes and assistance with toileting. Those assessed as having “moderate risks/needs” or below were deemed ineligible for funded personal support services and were not even added to wait lists. Instead, they were referred to community agencies, where they would in some cases have to pay out of pocket for the identical services.
Insufficient home-care services are responsible for major bottlenecks in hospitals, the auditor found. About 50 per cent of patients who could have been discharged if home-care services had been available had to wait in hospital an average of six days for the services. This has a domino effect, resulting in delays for surgery and long waits in hospital emergency departments.
Both opposition leaders criticized the government for failing to live up to promises to help seniors age at home.
The home-care system “needs to be overhauled significantly in this province,” NDP Leader Andrea Horwath said.
Conservative Leader Tim Hudak said the government is wasting too much taxpayer money on bureaucracy in health care.
“People are paying more and getting less in return,” he said.
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