Auditor General’s Report: Homecare in Ontario fails to deliver on promise – failing patients in need

Doris Galloway in her bedroom at her Oshawa, Ont. home on July 1 2015.

TerryLe Blanc had no idea what to expect from Ontario’s home-care system when he brought his elderly mother, Doris Galloway, home after she recovered from a badly broken shoulder.

Ms. Galloway, now 86, was living alone in Oshawa, just east of Toronto, when she fell in December, 2013. She lay on the floor for three days before police broke down her door at the urging of Mr. Le Blanc, who lived in Vancouver at the time.

The 55-year-old has since quit his hospital telecom job, given up his west coast apartment and moved in with his mother to care for her around the clock as she sinks deeper into the grip of dementia. 

The two are photographed in their Oshawa, Ont. home and at lunch at a local fish and chip restaurant , on July 1 2015. (Fred Lum/The Globe and Mail)

December 2, 2015

Toronto, ON: Homecare services in Ontario are failing to deliver on years of promises by the government and are failing patients in need, despite budgetary increases in recent years. The release of the AG report today validates the frustrations on the ground of older Ontarians and their families who need access to high quality homecare. The AG Report found that access to homecare is fraught by long wait times, services are dependent on location, and patients in many cases are not receiving appropriate levels of services.

The AG Report shows that homecare services delivered in Ontario are systemically underperforming in a number of crucial areas, despite years of government reports, promises of improvement, and increased funding.

“While CARP members welcome government initiatives to improve home care, the reality for too many is inadequate access and long wait times. If we want to fulfill the promise of home based and community care to avoid institutional care, ‎then structural and funding changes are needed immediately.” – Susan Eng Executive Vice-President CARP

The report identifies the following problems:

  • Whether a person receives personal support services, and the amount of service provided, if any, depends on where the person lives
  • Care co-ordinators’ caseload sizes vary significantly, and some exceed suggested ranges in standard guidelines, so there is little assurance on whether care coordination services were consistently provided to all clients
  • CCACs are not able to provide personal support services to the maximum levels allowed by law
  • Clients may not receive appropriate levels of services as CCAC care co-ordinators did not assess or reassess clients on a timely basis
  • Not all care co-ordinators maintained their proficiency in, and some were not regularly tested on, the use of assessment tools
  • Supports to caregivers such as family members of home-care clients are limited and not consistently available across Ontario
  • CCAC care co-ordinators may experience difficulties in effectively referring clients to obtain community support services because assessment information and waitlists are not centralized
  • CCACs’ oversight of contracted service providers needs improvement
  • Each CCAC’s performance is measured against different targets for performing client services

A CARP Poll from earlier this year shows that CARP members are experiencing the reality on the ground of uncoordinated services, long wait times, and insufficient access to much needed homecare services. One half of members polled nation-wide (two-thirds of whom reside in Ontario) report receiving home care or know someone who does. But, of that group, 70 percent rate the quality of care received as just between “good” and “fair” on a four point scale. Only 1 in 7 members polled rate the quality of homecare received as “excellent”.

On average, CARP Poll respondents waited 31 days for an initial assessment, a further 20 days for home care to start and all this despite an expectation that home care should begin within 10 days, on average, from the initial assessment.

CARP has long called for access to high-quality homecare services to allow people to age in place. Most recently, CARP has called for homecare as an integral component of patient centred care. The AG Report, however, proves that the goal of delivering prompt access to consistently high quality, coordinated homecare is far from reality in Ontario.

CARP is a national, non-partisan, non-profit organization committed to advocating for social change that will bring financial security, equitable access to health care and freedom from discrimination. CARP seeks to ensure that the marketplace serves the needs and expectations of our generation and provides value-added benefits, products and services to our members. Through our network of chapters across Canada, CARP is dedicated to building a sense of community and shared values among our members in support of CARP’s mission. CARP has 300,000 members nationwide.