Social Policy in Ontario

“I was terribly naive,” he says. “Even today I seem to be banging my head against a wall. No one is stepping up to answer my concerns.”

For the past four years, Williams has been trying to find out exactly how the hundreds of millions of health dollars earmarked annually for community and home care are actually spent.

Williams, who lives in Guelph and teaches accounting at a local college, is convinced health officials are misleading the public on how much money is spent on direct care for patients released from hospital and now requiring care at home or in their communities.

Officially, Community Care Access Centres (CCAC) in Ontario claim they spend 91 cents of every dollar they receive from the provincial government on direct client care.

But Williams, who has examined the budgets of all 14 CCACs in the province, says the figure is closer to 65 cents.

And in fact it may be barely 50 cents once the overhead, executive salaries and profits of the private companies that actually deliver health-care services in homes and the community are taken into consideration.

If true, that means up to half of the funds designated to help patients never reach the nurses, physiotherapists, speech-language pathologists, occupational therapists and personal support workers who actually treat patients.

Worse, no one at Queen’s Park or within the medical industry seems to care.

“Money that is supposed to be going for patient care is going to increasingly large bureaucracies,” says Williams, who wants to see more transparency and accountability by health officials.

Part of the money goes for successive layers of bureaucracy and high executive and managerial salaries (some CEOs of Local Health Integration Networks that oversee regional health are paid more than $300,000 a year).

In contrast, therapists and support workers who actually see and treat patients often earn little more than $30,000 a year, or less. Many of them have advanced university degrees and have worked in their profession for decades.

Also, most of these workers are hired by private, for-profit companies under contract to CCAC. These firms siphon off even more of the health dollars to pay their own executive salaries as well as providing profits for the company owners.

Williams started probing the CCAC financial statements in 2009 after he heard countless “horror stories” about health-care workers losing their jobs or seeing their incomes reduced because of budget cutbacks. One of those workers was his wife, who has been an occupational therapist for more than 30 years.

Williams’ main argument is that CCACs improperly include the work of care co-ordinators in their calculation of “direct client care.”

Formerly called case managers, CCAC care co-ordinators assess individual patient needs and determine the type and frequency of service required at home or in the community, such as a daily or weekly visit by a physiotherapist, based on their diagnosis and available money.

But care co-ordinators often never even see a patient. Rather, they make their assessment based on a phone call or by reading their medical charts.

Over the years, Williams has taken his fight to CCAC officials, health ministry bureaucrats and Queen’s Park politicians. Only seven of the 107 MPPS bothered even to reply to his request for a probe into his complaints.

Health Minister Deb Matthews wrote a terse, dismissive letter in August in response to his issues over CCAC accountability. She said nothing about looking into his complaint.

Finally fed up, Williams filed a formal complaint several weeks ago with the Ontario ombudsman against the CCACs for “false and misleading statements.” He is waiting to learn if his complaint will be investigated.

Williams admits he feels “very alone” in his four-year fight, but says he won’t give up. “I’m astounded by the lack of honesty, by the failure to be open, by the failure to respond to complaints” by health officials and politicians, he says.

After four years, David Williams deserves better from elected officials at Queen’s Park.

He deserves to be heard — and he deserves thanks from all Ontarians for shining a light on just where our health-care dollars really go.

< http://www.thestar.com/opinion/commentary/2013/10/16/searching_for_the_truth_in_health_spending_hepburn.html >