Social Policy in Ontario

She sits in her car and cries after telling a war veteran suffering from Parkinson’s disease that she can’t approve visits by a nurse to his home to give him the insulin he needs.

“What has happened to the beautiful home-care program that I love?” she asks herself as she wipes away the tears.

The woman, who asked that her name not be used for fear of being fired, is a care co-ordinator for one of the 14 Community Care Access Centres that govern home care in the province. She has just learned she couldn’t authorize the daily visits by a nurse because a computer program she must use to assess patient need indicated that he didn’t qualify for such service.

“I know through my clinical judgment as a registered nurse that this man needs help and we should just provide it,” she wrote in an email. “But the direction was that my judgment doesn’t matter,” she said, adding that she and other CCAC staffers “are very upset at having to reduce service to our clients, especially the most vulnerable frail and elderly people. In fact, we can barely give service to new clients.”

The CCAC worker is one of hundreds of readers who have emailed or telephoned me in the past three weeks after I wrote a series of columnsabout the rapid decay of Ontario’s home-care system, soaring CEO salariesand calling for a full public inquiry into CCAC finances and operations.

The readers include the chair of a CCAC outside of the Toronto area, backbench Liberal MPPs, a former top executive for a Local Health Integration Network, CCAC staffers, hospital employees, front-line home-care workers, owners of private home-care service providers, patients and their families.

Their anger and frustration is palpable, especially with Health Minister Deb Matthews, who many say is ineffective and should be fired.

They describe disturbing stories of how patients are pushed out of hospitals and lied to when told they would find adequate health care from the CCACs.

“My colleagues speak daily about the moral distress they experience as a result of feeling bullied by hospital administration to discharge patients home with less than adequate CCAC supports,” writes a social worker at a major Ontario hospital.

They write of their disgust with soaring executive salaries while wages for front-line workers are frozen. They cite examples of how vital services, such as speech language pathology and physiotherapy, are being silently slashed. They describe obscene levels of bureaucratic duplication and a toxic work environment filled with fear and intimidation.

All of them, including the CCAC and LHIN executives, ask that I not use their names for fear of either losing their jobs, the meagre services they do receive now or their company’s contract with the CCACs.

Among their major complaints are:

1. Soaring CEO salaries at CCACs and LHINs while low-income wages for most front-line workers have been frozen for almost the past 10 years. For example, the salary for Kim Baker, CEO of the Central LHIN covering north Toronto and York Region, rose $50,000 between 2009 and 2012 to $285,000. In the London area, the salary and benefits of Southwest CCAC boss Sandra Coleman jumped a whopping 144 per cent between 2006 and 2012.

2. CCACs have dramatically cut the hours and type of services available to many patients, especially those requiring rehabilitation services. That forces patients to pay out of their own pocket for needed services — or go without any help.

3. Barely 40 cents of every dollar earmarked by the government for home care actually reaches the front-line workers who provide the service. The rest goes for CCAC expenses such as rent, executive pay, patient assessment and profit and bureaucratic costs of private companies contracted to deliver the services.

4. Starting in 2011, CCACs began hiring palliative care and mental health nurses to provide services in direct competition with private home-care providers that they are supposed to oversee and fund. This is a major conflict of interest on the part of CCACs.

5. A culture of fear pervades the health-care sector. If they talk openly, patients are afraid they will lose what little service they have. Private service providers are afraid of losing their CCAC contracts. Health-care workers fear for their jobs. “As a CCAC staff member, I would certainly be fired for contacting you,” one reader wrote. Even professional associations keep silent for fear of retribution against their members by CCACs or the health ministry.

Matthews has done little to address these issues since becoming health minister in 2009.

Indeed, she has ignored repeated warnings of growing chaos, dismissing clear evidence that the home-care sector can’t cope with the government’s overall objective of controlling hospital costs by discharging patients with false promises of home- and community-care services that can’t be delivered.

Worse, under her watch she has failed to do anything to control salaries of CCAC and LHIN executives. Because of that, she has lost the trust and support of front-line workers, many of whom haven’t seen a wage increase in 10 years.

After ignoring the controversy for months, Matthews finally said on Tuesday she would welcome a full review and audit of the 14 CCACs by the auditor general. She made the comment only after Conservative MPP Christine Elliott demanded an inquiry and told the Ontario legislature that CCAC administrative costs and salaries are “unconscionable.”

While her statement is welcome, it appears that cleaning up the health-care mess is too big a job for Matthews.

That’s why it is critical that Premier Kathleen Wynne step in and take active control of the health portfolio.

Wynne should start by ordering an immediate wage freeze on top CCAC and LHIN executives, setting up a full audit and review of all CCAC operations, cancelling all planned cuts to current home-care services, especially rehab services, and demanding major funding increases for home care in the coming provincial budget.

Only through Wynne’s direct intervention can the province start addressing the health-care chaos — and delivering the level of services that needy patients rightly deserve.

< http://www.thestar.com/opinion/commentary/2014/02/26/kathleen_wynne_must_clean_up_homecare_mess_hepburn.html >