Home care urgently needs help

It’s quite a feat to mismanage an important health-care sector in a way that leaves both workers and patients dissatisfied — with no real plan to fix it — but that’s the situation in Ontario home care.

As Citizen reporter Joanne Laucius recently detailed, it has become difficult to attract and retain personal support workers in the numbers necessary to meet the demands of an aging population. Support workers complain of low pay, lack of respect, lack of professional status and work shifts that necessitate hours of unpaid time driving to appointments. The working conditions make it difficult to offer real help to those who need it. People are reluctant to do the job because we have treated the job as not worth doing.

Meanwhile, people who require help to stay in their own homes complain about long waits for service, not receiving the number of hours of care for which they are eligible, workers who don’t show up, and workers who lack training. Sometimes these are workers who have been arranged through the local Community Care Access Centre (CCAC), a government agency. Sometimes families have directly paid for caregivers from private agencies.

Ontario’s Progressive Conservative government has appointed Dr. Reuben Devlin to head a commission charged with ending the backups in our hospitals. Lack of timely home care is the main problem for hospitals, because it means they can’t discharge patients who are well enough to go home, and because inadequate home care in the first place can mean more folks ending up at hospital who might have avoided it with proper support.

Common sense and economics suggest a number of solutions.

First, the new government should spike a plan by its predecessor to create a new government agency for home care. It was to begin as a pilot project with the expectation that government would take over the sector entirely. The plan has been stalled by a court challenge by home-care providers. Good. Let’s fix the system we have, not create a new bureaucracy. Let’s work at strengthening our mix of private and publicly funded PSWs, which at least gives clients some alternatives.

But home care is only as good as the people working in it. The job needs to be made meaningful and rewarding — and acknowledged as such by everyone. A clear, publicly understood system of professional certification would help people know the difference between a PSW with sophisticated qualifications and one with fewer; pay scales could be set accordingly, allowing families some choice. Currently, the typical pay, just above the minimum wage, is unlikely to attract enough of the people Ontario needs. Both government and private agencies need to set more sensible work schedules to allow PSWs to make a real difference.

Patients need choice and a guarantee that they will get the service recommended by the government’s own Local Health Integration Networks. The best way to do that is to allow patients to contact service providers directly, then have them bill government. This would mean more home-care spending, but it is still the cheapest way to help people. Certainly cheaper than warehousing them in hospitals, which is the most expensive way.

Speaking of warehousing, the government has also promised thousands of long-term care beds over the next five years. We need them, but that isn’t a fix; it’s crisis management. Over the last decade, Ontarians have heard a lot of big homecare promises, but we’ve never had a plan that delivered. Let’s get on with creating one.