New road map crucial for home care
A damning report from the provincial auditor general drives home the reality that home care is easier said than done. And easier for politicians to promise than to deliver.
In the last provincial election, all three parties prescribed community-based care as the cure for all that ails the health-care system.
The NDP pledged a “five-day home care guarantee” — nothing if not a snappy slogan. The PCs proposed eliminating the same Community Care Access Centre (CCAC) model they’d created in 1996 to deliver home care, saying they’d streamline the process anew. And the Liberals repeated their perennial promise to boost spending.
No matter the party, the political pitch goes something like this: A tsunami of seniors is engulfing the $50-billion health-care system. Unless we adopt the more costeffective — and cure-effective — method of treating patients in a home-care setting, we will drown in a sea of red ink.
The political and economic appeal of home care is irresistible. It costs roughly $45 a day — one-tenth that of hospital care. It’s also more humane care if it is individualized, not institutionalized.
But when the system breaks down, the human costs are high. Home care is a lifeline for people who need their post-operative bandages checked — and if a nurse doesn’t make that first visit within 24 hours as scheduled, a patient might be rushed back to hospital with potentially life-threatening complications.
When that happens, the home care panacea becomes political poison. Stories of underperforming CCACs and overpaid CEOs prompted the opposition to call in auditor general Bonnie Lysyk last year.
What’s most jarring in her latest special report is the lack of due diligence by the 14 regional CCACs that co-ordinate home care and allocate long term care — and, by extension, the government that provides their $2.4 billion in annual funding. The report found wild inconsistencies in the way service is delivered, and how much service providers are paid for it:
Rapid-response nurses are supposed to make home visits within 24 hours of a patient being discharged from hospital, but they missed the deadline in nearly half of all cases.
Clinical care protocols — how, why and when bandages are changed, for example — can be dramatically different depending on what part of the province you live in. Remarkably, there are no provincewide standards, suggesting a lack of “best practices” that the medical community has been trying to follow for decades: “There is a risk that some patients may be receiving better care than others.”
Nurses employed directly by the CCAC generally don’t work weekends, forcing patients to wait them out, while privately employed nurses tend to offer continuity of care 24/7. The CCAC’s rapid-response nurses earn $40.80 on average, while nurses employed by private contractors for the CCAC are paid an average of $30 an hour.
Auditors being auditors — they are number crunchers, not health providers — they don’t say which wage rate is right, or which treatment is appropriate. But it’s worth asking why the health ministry hasn’t asked the CCACs to get it right.
CCACs risk becoming everyone’s favourite punching bags — especially when their CEOs keep shooting themselves in the foot. At a time of tight budgets and low wages for frontline workers, a few CCAC chiefs have helped themselves to handsome pay hikes averaging 27 per cent since 2009, despite moves by Queen’s Park to freeze managerial salaries.
Buried within that recurring bad news story is the more reassuring tale of three regional CEOs who quietly rejected pay increases awarded to them by their boards. According to the auditor’s report, one CEO explained that “the money should instead be available to other staff in the CCAC.”
(If not a raise, praise seems in order for these outliers.)
The Liberal government counters that even in a time of overall restraint, it boosted spending on CCACs by 26 per cent from 2010 to 2014, reflecting the higher priority of home care. Another $750 million has been allocated.
But when the health ministry provides the money, it can’t pass the buck. Not only should it hold the CCACs to a high standard of accountability, the health ministry itself must be accountable for how that money is spent.
In early 2012, then-health minister Deb Matthews proclaimed a new health-care “Action Plan” that would put home care on course. It didn’t.
Three years later, her successor as minister, Dr. Eric Hoskins, has put out a 10-point “Roadmap” to point the way again. Wisely, Hoskins has welcomed the auditor’s report and promised improvements.
That’s what prudent politicians do. But as a practising physician, Hoskins will be held to a higher standard.
Beyond his bedside manner, he has a doctor’s duty of care. Martin Regg Cohn’s Ontario politics column appears Tuesday, Thursday and Sunday. mcohn@thestar.ca, Twitter: @reggcohn