Recent negative headlines around provincially-funded homecare services have caught the attention CARP members who regularly interact with the provincial Community Care Access Centres (CCACs).
Ontario currently has 14 CCACs that provide and coordinate a number of government funded medical services from rehabilitation to personal support and homemaking, (food preparation, bathing, house cleaning) to more complex medical care provided by nurses. More than half of CCAC clients are over aged 65.
The CCACs were established by the Ministry of Health and Long-Term care in 1996 to help Ontarians access government funded home and community services and long-term care homes. The CCACs fund and provide homecare services to over 700,000 residents per year, spending $2.4 billion annually and they are often the first point of contact after a patient is discharged from an Ontario hospital.
Over the last two decades a number of deficiencies and inefficiencies in the CCAC model have been cited by patients and the government alike. In the fall of 2015, Ontario’s Auditor General, Bonnie Lysyk found that the CCACs were spending almost $1 billion, or 39% of their funding on administration. Lysyk found that patient experience varied between the 14 CCAC regions and that many of their programs including those for patients with developmental or mental health issues failed to meet their goals.
Ontario’s Minister of Health and Long-Term Care, Dr. Eric Hoskins accepted the auditor general’s report and promised to act on all of her recommendations. That led to many reports of the impending demise of the CCACs in Ontario as Minister Hoskins promised to take “bold” action on the homecare file.
The Auditor General, in her report, highlighted the fact CCAC executives received bonuses and raises despite an ongoing wage freeze in the public sector and that the average CEO earned $249,000 in 2014, and the highest paid CEO’s earning closer to $300,000. With mounting pressure on the CCACs and the sense that changes are imminent; the Toronto Star reported last week that twelve of the Critical Care Access Center’s CEOs had hired a prominent Toronto labour lawyer to represent their interests.
At a time where CARP members are recounting stories of their interactions with the CCAC and the difficulty in securing timely homecare services for themselves or their loved ones, they were angered to hear that the CEO’s were focused on protecting their own welfare and not exclusively on that of those in their care.
CARP Etobicoke Chapter Chair, Gary Hepworth says, “this is a huge issue for our members. Who is protecting the interest of the average healthcare user if CEO’s are protecting their own interest?” In Etobicoke, the problems of inconsistency in care are evident as there are four different CCAC’s serving the residents of that community. In some cases, patients on one side of the street are able to access more or better service from their CCAC than their neighbor across the street who falls into another CCAC catchment.
As the media quotes insiders, saying that the CCAC’s are on their way out, the Ministry of Health and Long-Term care has not indicated one way or the other what possible improvements would entail, and points to the recent Patients First Discussion Paper that lays out a plan to eliminate CCAC Boards and transfer service management and delivery from the CCAC to the Local Health Integration Network (LHIN) and the Ministry’s ongoing implementation of a ten point plan to improve homecare. Full-scale changes require extensive consultation with stakeholders including doctors and other health care service providers, followed by legislative change and subsequent organizational change that ensures no disruption of service, all of which would likely take well into 2017 or beyond.
CARP encourages Minister Hoskins and the Province of Ontario to proceed swiftly with the necessary changes to ensure the maximum amount of healthcare dollars are focused on patient services while rightsizing the bureaucracy to efficiently and effectively deliver services to Ontarians in their home and community, thereby realizing the savings that were initially envisioned by caring for seniors in their home, and minimizing the time patients spend in budget burning hospital environment.