Time for rethink on home care

TheStar.com – comment/editorial – Time for rethink on home care
January 24, 2008

Ontario Health Minister George Smitherman has waded back into the messy issue of “competitive bidding” in the home-care sector, a controversial inheritance from the Mike Harris era that the Liberal government was supposed to have fixed.

Yesterday, Smitherman halted the awarding of a home-care contract in Hamilton after the Victorian Order of Nurses and St. Joseph’s Home Care, which provide 80 per cent of home-care visits in the city, were eliminated from the bidding process by the local Community Care Access Centre.

Smitherman’s decision to intervene, prompted by a loud community outcry, means the two non-profit agencies will continue to serve patients for now. But it also calls into question the McGuinty government’s decision to try to tinker with a competitive model for awarding home-care contracts that many critics say simply doesn’t work.

Under the competitive bidding process introduced by the previous Conservative government, Community Care Access Centres across the province solicit bids for home-care contracts in their areas.

The model was intended to bring greater efficiencies to the sector. But it has long been criticized for pushing out non-profit community agencies in favour of for-profit companies, driving down wages and compromising quality of care, especially for patients with long-term relationships with their caregivers.

To address those concerns, the Liberal government asked former health minister Elinor Caplan to study the system. In her 2005 report, Caplan advised retaining competitive bidding, but proposed 70 recommendations to improve it, including offering longer contracts to agencies with good track records and improving benefits for staff. The government accepted the bulk of her recommendations.

Yesterday, Smitherman said he intervened in Hamilton because he was “disappointed with how the current process was unfolding.” He added that he would announce his next steps “in the near future.”

But Smitherman has already had a crack at tinkering with competitive bidding through the Caplan report. His decision to override the process in Hamilton raises serious questions about the effectiveness of the recommendations made by Caplan. Indeed, Smitherman’s move suggests the government will have to go back to square one and rethink the whole idea of competitive bidding in this field, where often frail patients are at risk.

“They should not be fixing something that is unfixable,” says Doris Grinspun of the Registered Nurses’ Association of Ontario.

Smitherman said yesterday he wants to give competitive bidding “some sober second thought,” but he would not elaborate.

Opponents of competitive bidding are calling for an indefinite moratorium on the competitive bidding process for all home-care contracts. Smitherman would not go that far. But with no new home-care contracts imminently up for renewal elsewhere in the province, Smitherman’s Hamilton move amounts to a de facto moratorium.

That should give the government an opportunity to re-examine the competitive bidding process from top to bottom. Given our aging population, the delivery of home care deserves no less.

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