How to save our health-care system from itself

Posted on December 4, 2015 in Health Delivery System – News/Queen’s Park – Home care is the future for Ontario’s aging population. But it has a messy past.
Dec 03 2015.   By: Martin Regg Cohn, Provincial Politics

Death notices are being written as you read this.

CCACs (Community Care Access Centres) are about to be decapitated — to save the patient.

For a little-known acronym, CCACs play an oversized role in the lives of the elderly. They deliver home care, nursing care and community care — be it regular bathing or changing bandages — outside a hospital setting.
Home care is the future for Ontario’s aging population, as the government tries feverishly to reduce hospital costs. But it has a messy past, as Wednesday’s report from auditor general Bonnie Lysyk attests.

The latest iteration of the perennial home-care horror story casts CCACs as an irretrievably tainted brand, raising questions about the $2.5 billion that goes to 713,500 patient clients every year. In Ontario, home care is like shopping for a new home — susceptible to seasonal variations and local market conditions:

In winter, CCACs routinely scale back patient treatments because they are low on cash as the fiscal year-end approaches. Quality control is out of control because different CCACs treat the same patient conditions differently, depending on geography.

Two-thirds of home-care assessments weren’t conducted within promised deadlines, and some patients still hadn’t been reassessed in a year, according to the auditor’s probe. And CCACs seem reluctant to crack down on private contractors who fail to deliver on nursing services as promised.

After 12 years in power, the governing Liberals own the CCAC mess. Now, Health Minister Eric Hoskins has a plan to put them out of their misery, so that patients can breathe easier.

In public speeches, and an internal ministry discussion paper, Hoskins is hinting at reforming the system in a “bold and transformational way.”

That transformation could translate into severing the head(s) of the CCACs — above the white collar level. The jobs of frontline nurses and care co-ordinators won’t go away, but some of the regional CEOs who gave themselves double-digit pay hikes — while their agencies failed to deliver as promised on patient care — are in the government’s sights.

A true transformation requires a new destination, not merely a name change.

But one option for the fading CCACs is to resurrect them under the rubric of another obscure acronym, the LHINs (Local Health Integration Networks). The little-known LHINS are regional powerhouses that disburse more than half of the health ministry’s annual budget of about $50 billion, allocating funds among hospitals and other health providers.

CCACs have developed such a bad reputation that they are probably irredeemable. But the LHIN brand is also burdened by heavy baggage, according to the auditor.

While the first chapter of her annual report eviscerates CCACs (in addition to her special report critiquing them last September), the auditor devotes another chapter to the problem-plagued LHINs, echoing many of the same criticisms: People living in different parts of Toronto can face longer waiting lists depending on which of the five LHINs that oversee the city they happen to fall under.

Hoskins hopes to bring greater accountability to home care by bringing the existing CCAC framework under the control of LHINs. His problem is that LHINs fly at 30,000 feet, allocating and co-ordinating resources from afar, not delivering frontline care at ground level the way CCACs do.

In the province’s teetering health-care pyramid, the 14 regional CCACs are funded by the 14 LHINs that cover the same territory. The LHINs, in turn, are funded and controlled by the ministry.

While it’s easy to blame CCACs for going astray, the bucks flow from the LHINs and the buck stops with the health ministry, which isn’t doing its job of oversight: “The ministry takes little action to hold the LHINs accountable to make changes when low performance continues year after year,” the auditor concludes.

The biggest problem with LHINs, however, is that they have so little control over primary-care doctors, who comprise a key component of the health-care system. The auditor general isn’t the first to note this anomaly — a slew of recent reports and studies have urged Hoskins (a doctor) to bring physicians under the ambit of LHINs so that they can truly integrate the system, as their acronym implies.

That too is part of the plan, sources say. Fold CCACs into LHINs. Bring doctors under LHINs. And for good measure, rename LHINs into something more than an obscure acronym that resonates only with the medical-industrial complex.

Let’s see if the good doctor can help an ailing system heal itself.

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