Ontario must fast-track home-care investment

Home may be where the heart is, but if you need professional health care you might well have to look elsewhere.

That’s something Ontario can change in its 2023 budget, however, provided the province follows the recommendations of Home Care Ontario and the Ontario Community Support Association.

At the moment, an estimated 15,000 Ontarians are waiting for home care. And according to a survey conducted last November, that number could increase substantially since 76 per cent of home and community care organizations said that without an infusion of cash they will have to either cut services or increase wait-lists.

The problem stems not so much from a lack of funds for longterm care (LTC), but from how that cash is utilized. Canada has long put the priority on institutional care — hospitals and nursing homes — over home care.

According to the National Institute on aging, in 2019 Canada spent just 18 per cent of its LTC dollars on home and community care — just half of what comparable countries in the Organization for Economic Co-operation and Development spent on average.

This deprioritization of home care hits those who work in the sector right in their pocketbooks: If you’re a personal support worker (PSW) in Ontario, you can take a job in a hospital or you can work in home care — for nearly $5 an hour less. And if you’re embarking on a nursing career, you’ll be out nearly $11 an hour if you choose home care over hospitals.

Needless to say, most nurses and PSWs opt for institutional work, which has resulted in a 12.8 per cent vacancy rate among these positions in the home and community care sector. That, in turn, has led to people occupying acute care hospital beds while they await placement in a long-term care institution.

The financial impact of this is considerable. While hospital stays cost an average of $730 a day, the daily price of home care is just $103. And even when patients receive an LTC placement, it comes at twice the price of home care.

To make matters worse, an estimated one in nine Canadians admitted to nursing homes don’t need to be there. Rather, they could remain at home with proper support, and home is exactly where most people say they prefer to be.

To be sure, Ontario has recognized the value of home care, and in last year’s budget the province earmarked $1 billion over three years for the sector. But as Ontario prepares its 2023 budget, it needs to ensure it gets the most bang for those bucks.

Home Care Ontario, which represents providers across the country, emphasizes the need to stabilize the sector by attracting nurses and PSWs back to home care. That means closing the pay gap between home and hospital work. According to the organization, a 10 per cent wage increase would bring 1,265 PSWs back to home care.

Better yet, this can be accomplished without an injection of new funds. Rather, Home Care Ontario recommends the province fast-track the money earmarked in last year’s budget, rather than distributing it over three years.

Fast-tracked funds could also help to improve capacity and alleviate pressure on acute care, and to invest in care innovations, all of which could ultimately add 2.7 million home care hours in Ontario.

The Ontario Community Support Association, which represents non-profit providers, also calls for the strategic allocation of committed funds. And while the organization recommends that the new budget include an additional $212 million for the sector, it also advises eliminating the red tape that currently undermines providers’ ability to maximize the use of their existing funds.

These recommendations suggest that while the home care sector can benefit from more cash, already committed funds can also make an enormous difference — provided they’re put to use properly, and at the right time. That’s the task for Ontario’s 2023 budget: Use the earmarked funds strategically, so that front-line staff really can go home again.