Urgent need for Ontario home-care task force

Posted on September 27, 2015 in Health Delivery System

TheStar.com – Opinion/Commentary – A new report by Ontario’s auditor general outlines a costly, inefficient home-care system in chaos.
Sep 27 2015.   By: Bob Hepburn Politics

In the wake of a major report that blasts the way Ontario looks after home care in this the province, it is time Ontario Health Minister Eric Hoskins took immediate action to fix a system that is clearly broken.

The latest horror-filled report, released last week by Auditor General Bonnie Lysyk, outlined a system that is utterly confusing, often mismanaged, lacking in oversight and filled with inconsistencies in how patients are treated.
Lysyk took particular aim at the 14 Community Care Access Centres (CCACs), the publicly funded organizations that co-ordinate nursing, therapy and personal support services for patients outside of hospitals.

Basically, her report described a troubling situation where Queen’s Park champions the huge CCAC bureaucracy that costs too much money and does nothing very well.  Among her findings was the stunning revelation that more than $900 million of the $2.4 billion that CCACs receive annually to deliver for home- and community-care services actually go for administration and overhead — not direct patient care.

In fact, barely 62 cents of every $1 goes to actual direct patient care. For years, CCAC bosses have being boasting — falsely it turns out — that 92 cents of every dollar went to direct patient care.  Lysyk’s audit also found that barely half of the complex-needs patients discharged from hospitals receive the care they are supposed to get within 24 hours, often because CCAC nurses don’t work on weekends or rarely after 5 p.m.

The audit was requested by the Ontario legislature’s standing committee on public accounts in March 2014 after a series of news stories and columns in the Toronto Star in 2013 and early 2014 detailed the beleaguered state of the home-care system, particularly when it comes to the CCACs.

The Star described how CCAC executives were getting massive pay raises despite the system being starved for money with patients suffering as their services were cut and many front-line workers were overworked and without a wage increase in years.

The auditor general’s report comes six months after a report by the Liberal government’s own expert panel, chaired by Gail Donner, a former dean of nursing at the University of Toronto that called for “urgent action” to fix the chaos in the system.

Despite these two major reports and similar reports in years gone by, the Liberal government has done nothing to address the troubles within the CCACs.
Now it’s up to Hoskins to act boldly and quickly to fix the system.

As a first step, Hoskins should immediately create a powerful task force that can review the CCACs and look for a better way of co-ordinating home-care in Ontario. Ultimately, that could mean scrapping the CCAC system, which as Lysyk’s report finds, is simply not working.

The task force should be composed of experts from all sectors of the health area, including representatives of hospitals, patient advocacy groups, nurses, therapists such as speech language pathologists, personal support workers, CCACs and the 14 Local Health Integration Networks (LHINs) that oversee and fund CCACs, hospitals and other community health services.

Also, Hoskins should give the task force a short deadline to report its recommendations, ideally within six months. That’s a tight schedule, but it should be possible given that so much investigation has been done over the last five years into the flaws in the system.

One specific mandate that Hoskins should give the task force is to determine if all planning and monitoring roles for home care now performed by CCACs can be transferred to beefed-up LHINs.
Also, the task force should study whether care coordination now handled by CCACs can be transferred to the primary-care sector.

Hoskins, who has talked of wanting “bold and transformative change,” has hinted broadly that he is willing to look in this direction.  He has taken great efforts to point out the auditor’s recommendation that the government revisit the current model of delivering home and community care. “We endorse this recommendation and see it as a catalyst not only to continue but to deepen our reform process,” he said.

The auditor general will release two more reports on home care in 2015, both to be included in her annual report to be filed likely in early December. One is on the CCAC’s home-care program focusing on personal support services and the other on the performance of the 14 LHINs.

But Hoskins doesn’t need to wait for these reports before acting.  The evidence that the home-care system is a mess and that the CCACs are a big reason for that sorry state is overwhelming.  It’s time for Hoskins to appoint a task force with a mandate to propose real reforms that will improve the lives of all Ontario patients who need treatment at home.

< http://www.thestar.com/opinion/commentary/2015/09/27/urgent-need-for-ontario-home-care-task-force-hepburn.html >

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