Ontario is courting a home-care fiasco

TheGlobeandMail.com – Opinion
March 1, 2018.   

Back in October, in a routine news release about home-care funding, the Ontario government made a passing reference to the creation of a new agency.

Soon after, CBC journalist Mike Crawley obtained internal documents that revealed details of the new institution: Personal Support Services Ontario (PSSO) is going to recruit, train and employ personal-support workers and provide care to a select group of home-care clients.

The agencies that provide home care were gobsmacked, and now they’ve taken legal action to prevent the government from following through on PSSO.

In documents filed in court, a coalition of 11 not-for-profit and for-profit home-care providers who, between them, provide 95 per cent of home-care services in the province, allege that the move “will have dire consequences for patients and their families, for service providers and their employees and for the home care and health care systems at large.”

At first blush, this looks like businesses protecting their turf. But the possibility that this could actually worsen patient care is worrisome. (The allegations in the lawsuit are unproven and the government has yet to file a legal response.)

Ontario spends about $2.5-billion a year on publicly funded home care, providing care to about 700,000 patients. Most of them receive short-term services, usually after discharge from hospital. But a small and growing number of patients with complex chronic illnesses receive home care for years, sometimes on a daily basis.

This group of high-users (meaning 14-plus hours a week of home care) has been clamouring for self-directed care – the ability to hire the workers they need when they need them, within a budget that is allocated to them. It’s an approach that works well elsewhere. The new agency, PSSO, is going to provide workers for self-directed care, initially for about 6,000 patients.

But why is a whole new bureaucratic structure needed to provide a service to a small group of patients? The answer, according to the lawsuit, is that this is the thin edge of the wedge, and that by the time PSSO is fully operational in 2021, it will provide about 40 per cent of home-care services. (That, according to the leaked government documents.)

That would be devastating to existing agencies, including iconic organizations such as the Victorian Order of Nurses and Saint Elizabeth Health Care. While patients are frustrated by lack of availability of home care, there is no issue with the quality of care these agencies provide, and there is no reason they cannot provide self-directed care – if the government provides funding for them to do so.

So why destroy them? What sense does it make to take thousands of personal-support workers and make them employees of the state instead of employees of non-profit and for-profit companies?

The motivation, according to the lawsuit, is the Liberals are creating the agency as a political gift to major donor SEIU Healthcare, to allow it to recruit more union members. A rival union, OPSEU, makes the same allegation. Vic Fedeli, the interim Conservative leader, raised it in the legislature this week, calling it an “SEIU-backed agency.”

The new Health Minister, Helena Jaczek, did not respond to the charge of political payback; rather, she repeated the departmental soundbite that the agency will help patients navigate the system more easily.

The government has not made a compelling case for that at all. It beggars belief that more bureaucracy will equal better patient care.

As the employers say in their lawsuit, there is every reason to believe the new structure will make it more difficult and expensive to deliver care because 1) if PSSO has a monopoly on training workers and becomes the central employer for PSWs, the supply of workers for other providers will dry up and wages will be driven up, and; 2) home care is provided by teams of nurses and PSWs (and other specialists), and if PSWs work for one agency and nurses for another, it will be more difficult, not easier, to co-ordinate the provision of care.

There are two distinct issues here: Do home-care clients deserve more choice and flexibility? Absolutely. Is the way to do that creating a new layer of bureaucracy? That question answers itself. Home care has been mess for years in Ontario. Each “fix” seems to make a bad situation even worse. It’s time to let the good providers we have innovate and expand, not to burden patients with more red tape and shackles.


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