Social Policy in Ontario

Bring it on.

Those weren’t the precise words, but that was certainly the attitude of Ontario Health Minister Deb Matthews this week when the opposition demanded that the auditor general investigate soaring executive salaries and administrative costs in the province’s struggling home-care system.

Matthews may regret her hubris if the public learns the full extent of spending within Ontario’s 14 Community Care Access Centres, each with an average budget of $154 million for home-care services.

In the interests of Ontario’s rapidly aging population, auditor general Bonnie Lysyk should accept the request from Progressive Conservative deputy leader Christine Elliott and investigate spending by the CCACs. The elderly and infirm should not be sacrificed for executive empires.

As the Star’s Bob Hepburn has written, CEO salaries are jumping between 50 and 144 per cent, with some top executives earning nearly $300,000 a year. Despite this, most personal support workers — the front-line staff patients rely upon for the majority of their care — earn just $20,000 a year. It’s a stark example of flawed priorities.

At the same time, sick and vulnerable patients begging for care are refused services, often because the CCAC computer model, with its financially strict definition of need, rules out humane treatment.

As Hepburn writes, there’s a clear and growing anger directed at Matthews by nurses, front-line workers and former executives, most of whom are too afraid of retribution to speak on the record.

A major complaint? Some 60 cents of every dollar goes to CCAC bureaucracy — rent, executive pay, patient assessment and the costs of the private companies that are contracted to provide home care. When executives draw huge paycheques and nurses are forced to deny care for elderly war veterans, the system is clearly broken.

Times have changed since a 2010 audit was done. Under Matthews’ watch, hospitals are sending patients home sicker and quicker but the CCACs are not meeting care demands for frail, vulnerable citizens. It’s a shame.

That’s why an audit, focused on recent spending, could highlight the problems that well-paid professionals clearly won’t control. As Elliottparaphrased one home-care worker, “The CCACs are great at spending dollars to save nickels.” That’s telling.

While the auditor can dig into home care’s financial details, there is no doubt that health-care dollars are stretched thin, especially as Ontario’s massive boomer demographic ages. Matthews has repeatedly said she’s trying to meet this challenge though home-care services that keep patients out of expensive hospital beds.

She also recently acknowledged the poverty-level wages earned by personal support workers and promised they will receive raises, although the details remain sketchy.

According to the Star’s Richard Brennan, Matthews says the solution lies with Liberal government plans to introduce legislation that would limit executive salaries, controlling wages across the broader public sector. While it could be helpful in the future, that proposal won’t limit CCAC spending on administration or bureaucratic duplication. Again, a new audit could examine these issues.

Indeed, the Service Employees International Union, which represents many front-line home-care workers, has long called for a review of the sector. “You continue to see what I think is outrageous use of public funds . . . it is just a waste of money,” says union president Sharleen Stewart.

Matthews and Premier Kathleen Wynne are rightly facing tough questions about their health-care priorities.

It’s clear that runaway spending has benefited a few fortunate bureaucrats at the expense of the sick and fragile. Only strong political will, bolstered by a looming audit, will fix this sorry mess.

< http://www.thestar.com/opinion/editorials/2014/02/26/ontarios_auditor_should_investigate_spending_in_homecare_system_editorial.html >