A golden chance to fix Ontario’s home-care system

After years of denying anything was wrong, the Ontario Liberal government must now face the truth that it’s made a mess of home care in this province.

At the same time, though, the government has just been handed a golden opportunity to fix a system that is failing patients, is underfunded, is too confusing, is too heavy with bureaucrats and is forcing people to pay more of their own money for needed services the government should provide.

The stark reality of how bad the home- and community-care sector is currently was driven home last week by two major reports, including one by the government’s own expert panel on home care that declared “urgent action” is needed to remedy the chaos in the system.

The report by the panel chaired by Gail Donner, former dean of nursing at the University of Toronto, has the real potential of kick-starting a massive restructuring of how patients across the province receive care at home.

It came just days after the Ontario Health Coalition released its own scathing report. The coalition said the cash-short home-care system can’t keep up with growing demands as hospitals, eager to save money, send patients home “quicker and sicker.”

Patients are being discharged from hospitals without any home care or are being cut off from services they desperately need due to a lack of adequate funding for home and community care, says Natalie Mehra, the coalition’s executive director.

The government spends just $4.3 billion a year of its overall $50-billion health budget for care at home and in the community.

In its report, the Donner panel made 16 recommendations ranging from developing a system that focuses on patient needs instead of those of service providers to putting more money into the system.

Importantly, though, the expert panel has opened the door for Premier Kathleen Wynne and new Health Minister Eric Hoskins to completely overhaul the entire structure of the home-care system.

Such an overhaul could mean the demise of much-criticized Community Care Access Centres (CCACs), which co-ordinate home and community care for patients who are discharged from hospitals, and increase the role of Local Health Integration Networks (LHINs), which oversee health-care planning in regions across the province.

Many health-care experts contend that former health minister Deb Matthews spent years making the CCACs the centre of power for home care, despite mounting evidence they were ineffective and obstructionist.

Under Matthews, the CCACs operated with little oversight, creating fiefdoms where private-service providers who were critical of their practices saw their contracts not renewed or their funding reduced.

Widespread cases abound of how CCACs, which receive about $2.4 billion a year, have unilaterally cut off in-home services for needy patients or denied services, particularly in rehab therapy areas, to patients discharged from hospitals. Meanwhile, salaries of top CCAC executives have soared dramatically while incomes of front-line care workers have stagnated or in many cases actually fallen.

Although the panel of experts was not assigned specifically to study it, the structure of the homeand community-care sector was a major concern for patients, their families and service providers. They told the panel they had to deal with an inefficient, cumbersome structure that is failing to deliver services that patients need.

In an interview, Donner described the issue of structure as “the elephant in the room.”

The panel’s report declared that it “is clear that the current structure is not working” and urged “that the sector’s immediate efforts address the functional changes needed. If form follows function, we believe that the structure we need to enable and sustain these functional changes will become clear over time.”

That’s a clear message to Wynne and Hoskins that the panel believes it’s time to blow up or radically alter the role of the CCACs and LHINs.

Currently, the CCACs are at the centre of the “structure.” But in its report, the panel virtually ignores them. Instead, it suggests LHINs should oversee home care, identifying and correcting gaps in care and bringing more accountability to the sector.

When the CCACs were created, those functions were to be a huge part of their role.

So what happened? Is the omission of any talk of the role of CCACs deliberate? Is it a signal that the panel believes the CCACs should be abolished or greatly reduced and the job of assessing and assigning at-home care handed over to LHINs?

Encouragingly, Hoskins said in a news release the panel’s recommendations “will be an important guide as we improve and transform the home and community sector.”

In the coming months, though, Wynne and Hoskins must consider some major questions in the wake of the two reports last week. The biggest question is whether they have the appetite to dismantle the CCACs that Matthews, who remains a powerful cabinet minister, spent years building up.

Everyone agrees it will be tough to change a system that has become so entrenched. But as the expert panel’s report shows, change is desperately needed — and fast.

For Wynne and Hoskins, this is a golden opportunity to fix our ailing home-care sector. They should not waste it.