In early December, Ontario Auditor-General Bonnie Lysyk released her office’s annual report, which examined fourteen different publicly funded programs to determine whether or not the provincial government is serving citizens properly. Ontario’s home care, long-term care, and community care access services were among those Lysyk chose to scrutinize, and what she discovered over the course of her investigation is far from encouraging.
Home Care and Community Care Access Centres
Since 2008, spending on home care services has increased by 42%, and the number of clients served by the system has increased from 586,400 to 713,500. In years to come, it is expected that even more elderly Canadians will seek home care. However, according to the Auditor-General’s report, many older Ontarians are unable to access home care services in anything approaching a timely manner. Some wait more than a year just to receive an assessment.
The AG Report found that level and quality of care delivered depends on where a patient lives. Community Care Access Centres (CCACs) are generally tasked with providing home care services, but, due to regional funding inequities, each centre must develop its own criteria for care. As a result, the amount and quality of care available varies widely across Ontario. A person may receive a specific quantity of personal support service from one CCAC and much less support service from another centre.
Although the Office of the Auditor-General conducted a review of Ontario’s home care system five years ago, identifying many problems, the province has yet to meaningfully address many of these concerns. Since the 2010 report, Ontario’s government has yet to establish provincial standards for the level of care to which clients are entitled, or to distribute funding equally between CCACs.
In the absence of adequate funding for CCACs, health care workers become overburdened, and older Ontarians don’t get the care they need. At three CCACs audited, 65% of initial home care assessments were not completed within the required time frame. One care coordinator was overseeing the care of 170 separate chronic clients, despite the fact that the Ontario Association of CCACs’ guidelines say no coordinator should be responsible for more than 100 clients. The same guidelines allow clients to receive up to 90 hours of personal support services per month, but, due to underfunding, it is common for care coordinators to limit personal care delivery to 60 hours per month. Wait times for a number of services, from adult day programs to supportive housing programs, wary widely between CCACs, and are not meeting demand.
Local Health Integration Networks
According to the Auditor General’s report, not one of Ontario’s fourteen Local Health Integration Networks (LHINs) has met all of the performance targets laid out by the Ministry of Health. Rather than strive to meet targets, however, the Ministry has relaxed targets to accommodate underperformance throughout the system. Furthermore, according to Lysyk, “the Ministry has not clearly defined the attributes of an ‘integrated health system,’ nor does it have any way to measure how effective LHINs are as planners, funders, and integrators of health care.” As a result, the Office of the Auditor-General does not “have any way to measure how effective LHINs are as planners, funders, and integrators of health care,” or to “determine whether [LHINs] are delivering value for money.”
While performance in a few areas has improved since the LHINs were formed in 2007, it has stagnated or deteriorated in a majority of areas. Gaps in performance between LHINs have widened as well; in 2015, patients of the worst-performing LHIN waited thirty-one times longer to receive semi-urgent surgery than those in the best-performing network. Unfortunately, the quality of care a person receives seems to be almost entirely dependent on their postal code.
LHINs have not yet established frameworks to share and identify best practices, nor have they attempted to create standardized approaches to addressing common issues throughout the health system. There is no common complaint management process across LHINs, meaning that some LHINs fail to ensure patient concerns are resolved. Worst yet, it is incredibly difficult to measure the economic efficiency of the LHIN system, because methods of group purchasing differ from region to region. As a result, there is no way to easily determine whether or not taxpayers are receiving value for money from their LHINs.
The Auditor-General’s report revealed that the Ministry of Health and Long-term Care fell behind on critical incident and complaint inspections at long-term care homes throughout the province, with a backlog of incident and inspection reports doubling between December 2013 and March 2015. In some cases, days passed before high-risk complaints were addressed, which should have triggered immediate inspections. Medium-risk complaints, such as incidents of verbal or physical abuse of residents leading to minor harm, often took over a month to investigate.
Long-term care homes lag in other areas as well. In one region, homes failed to comply with nearly 40% of the Ministry’s compliance orders. In 380 cases, the Ministry failed to follow up on compliance orders within thirty days to ensure deficiencies had been addressed. Nearly 150 compliance orders went completely unaddressed. Homes are given inconsistent deadlines for fixing issues identified by inspectors. In some regions, homes have an average of 34 days to comply, and in others, they are given an average of 77 days. As a result, quality and safety of care can differ broadly from region to region.
The Ontario Government has shown a willingness in the past to improve home care and related services. In the last provincial budget, home care was one of the few areas of the health budget to get an increase in funding. But, the Auditor’s Report shows that coordination and political will are just as important to improving service quality and delivery, and to get the most from money invested into the system.
CARP has long advocated for expanded and improved access to home care, a better-coordinated and more patient-centred health care system, and increased standards of care provision in long-term care homes. As the provincial government reacts to the findings in the auditor-general’s report, CARP will continue to monitor new developments and push for the improvements necessary to ensure older Ontarians enjoy a high quality of life.
Auditor General’s Report: Homecare in Ontario fails to deliver on promise – failing patients in need
GFB Podcast with CARP Director of Policy Michael Nicin: Ontario’s auditor general says home care failing the people it was designed to help
December 14, 2015