Ontario home-care plan a bold step
Ever since he became health minister in 2014, Eric Hoskins has been unafraid of taking bold steps to deal with Ontario’s troubled health-care system.
Hoskins did it when he stood up to the powerful Ontario Medical Association and its demands for huge jumps in doctors’ fees and he did it when he dismantled the bureaucratic-heavy Community Care Access Centres that oversaw home care in the province.
Now he’s at it again with a bold move aimed at improving the way patients with high needs receive care at home.
Without any fanfare, Hoskins has approved the creation of a new government agency, the awkwardsounding Self-Directed Personal Support Services Ontario (SDPSSO).
First revealed by the CBC’s Mike Crawley, the agency will help co-ordinate how patients select and schedule personal support workers.
The move is a welcome and long-overdue initiative. If successful, it will address deep concerns by homecare patients who have no control over the hiring or scheduling of personal support workers.
Proponents of the new agency say it is the best system for high-needs patients who are hardly in a position to go shopping for a personal support worker (PSW) and for the workers themselves, who now often toil with part-time hours, split shifts and low pay.
Critics are outraged, though, claiming Hoskins is merely creating a costly government bureaucracy that duplicates work now performed both by forprofit companies and non-profit agencies.
Leaders of these agencies claim they were “blindsided” by news of the new agency. They fear they will be competing with the agency for contracts and PSWs, who could be enticed to sign up with promises of more steady work, and better pay and benefits. They also say Hoskins failed to fully examine alternative systems elsewhere in the world.
Home care has been a mess for decades. Successive governments have tried to fix it by tinkering at the edges. But Hoskins is acting boldly even if it doesn’t please everyone in the sector.
Ontario spends about $2.5 billion a year on home care. The money goes for such services as nursing, physiotherapy and speech-language therapy. A huge part of the money is spent on personal support services, such as help in getting patients dressed, bathed and going to the toilet.
Nearly 750,000 Ontarians receive home care each year. Most of those require care for only a few days or weeks after leaving a hospital. But many others require extensive, continual care.
For years, these patients and their families have lobbied for “self-directed” care, where they can personally choose their own PSW and arrange a schedule that works best for the patient.
Currently, patients are assigned a PSW by a private or non-profit agency and must be available according to the PSW’s schedule, not their own.
However, health ministry officials concluded that many patients who wanted to hire their own PSW have little knowledge in dealing with employer taxes, employee benefits and how to conduct background screening of PSWs.
Under the new plan, patients with high needs, such as adults with acquired brain injury, who require at least 14 hours of support a week, will be eligible to participate in the new program.
The new agency will be responsible for working with the 14 Local Health Integration Networks (LHIN) in Ontario to directly recruit, screen and employ PSWs; working with LHINs to receive client referrals and follow the plan of service; managing client intake and matching with PSWs; and facilitating client scheduling of services.
The agency will open next spring. It will start by working in three of the province’s 14 LHINs, with the full program in place within three years. The agency, which is expected to be headed on an interim basis by Barry Monaghan, a longtime Toronto-area healthcare executive, will have an initial annual budget of $3 million.
Clearly, many details of how the agency will operate still need to be worked out. The province is promising to work with current providers to develop a system that benefits everyone.
However, the real issue is not whether a private company will lose business.
Instead, it’s about helping high-needs patients deal with the shortage of workers, missed visits, poorly trained workers and high PSW turnover. All of these are more of a problem than most of us think.
Home care should be a professional, stable and high-quality service available to all.
Creating an agency to ensure the most deserving patients get the service they want — and at a time they want — is a huge step toward achieving that goal. Bob Hepburn’s column appears Thursday. bhepburn@thestar.ca