April 28, 2015
Homecare for the Future
Dr. Pat Armstrong, Dr. Hugh Armstrong, Dr. Sheila Neysmith
When public health care was established in Canada, those with complex care needs went to and stayed in either an acute or a chronic care hospital until they recovered. In hospital, comprehensive care was and is covered by the public purse. Today, many with complex needs are sent home, where there are significant limits on what care is publicly paid for. With drastic hospital cuts continuing, homecare priority increasingly goes to those with high clinical needs. The frail elderly and those with disabilities are much lower down the list. Even when deemed eligible for public homecare, individuals and their families must now pay more of the direct and indirect costs, or go without. Acknowledging this crisis, the Ontario government appointed a panel to investigate. Meanwhile, the Ontario Health Coalition conducted its own province-wide community consultations.
Released in mid-March, both reports expose similar problems. There are not enough services. The burdens on both paid and unpaid care providers are excessive. The administration and allocation of services appear, and are, complex, arbitrary and unequal. Through competitive bidding processes, governments have created a system rife with duplication, high administrative costs and conflicting goals. The government’s Community Care Access Centres (CCACs), responsible for determining eligibility and access, now oversee hundreds of contracts with private companies and thousands of different billing rates. Every provider firm has its own duplicate administration and scheduling regimes. Because most contracts are held by private companies with profit-taking built into their pricing, significant public dollars go to profit rather than to care. As a result individuals needing homecare cannot readily find their way through the system. And they get inadequate services.
Both reports conclude that unpaid care providers need more support, that the system should be more transparent, and that eligibility criteria should be more equitable. But there are major differences in the solutions they offer. The government report, Bringing Care Home, recommends new contracting systems, with for-profit and non-profit companies and the CCACs vying for contracts and then sub-contracting to another tier of companies. In other words, the government panel would address the problems created by contracts by creating more contracts. Such an approach would further fragment homecare and pull resources away from actual care. Moreover, the government panel recommends moving the contracting system from the CCACs to the province’s Local Health Integration Networks. But the LHINs have no direct experience with homecare. Shifting contracting to them would fail to address any of the complaints about unresponsiveness, poor communication, duplication, poor oversight and inflexibility.
The Ontario Health Coalition report, The Care We Need, recommends instead a system built on the Canada Health Act principles of universality, accessibility, comprehensiveness, portability and public administration. For the OHC, improving access to publicly-funded care is paramount. We concur. The full range of homecare services, including rehabilitation, supportive, palliative and respite care, as well as mental health services should be publicly funded. The OHC notes that per client spending on home care has actually declined since 2002/03, even without taking inflation into account and despite intensified acuity levels. It also points out that integrating our fragmented system into a streamlined public non-profit one could improve management and communication, reduce duplication and shift resources to care. Reforms should also make for decent pay and working conditions, as well as continuity of employment and care provision, reducing the alarming work force turnover rates while improving care. Although respite care and better information would help unpaid care providers, more paid services more equitably provided would be more important. Such a system can be built on the strengths and experience of the CCACs.
Based on decades of homecare research and involvement in various community healthcare organizations, including a CCAC Board, we are firmly convinced that only an expanded, non-profit system can address the moving testimonies that both investigations revealed.
Pat Armstrong is a Distinguished Research Professor at York University; Hugh Armstrong is a Professor Emeritus at Carleton University; Sheila Neysmith is a Professor Emerita at the University of Toronto and a Care Watch Board member.
Care Watch is a volunteer- run, not-for-profit advocacy organization led by seniors.
We work with policy makers and those who influence policy. As well, through public events and research we raise issues relative to older people. We drive positive action.
OLDER PEOPLE IN ONTARIO MUST HAVE:
CHOICES – Opportunities to make choices that will enable living at home with dignity and as much independence as possible.
A VOICE – The right to be involved in decisions about policies and practices that affect their lives.
SUPPORT – Access to services and programs that help them to be productive, active participants in their own communities.
Care Watch fights for services and programs that facilitate “aging at home”. Read our Pragmatic Proposal
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Nov 19, 2014
Annual General Meeting
Please join us for Care Watch’s Annual General Meeting, 2014 “Mobilizing Against Ageism!” Thursday, December 4, 2:00 – 4:00 pm, at the Older Women’s Network. This year’s program will feature a presentation and workshop on strategies to eradicate ageism through direct action.
Add your voice. Act with us.
Click here to view the event invitation.
Sept 22, 2014
Globe and Mail health columnist Picard cites 2014 Statistics Canada Study to highlight the unmet home care needs of Canada’s growing elder population. Please visit our Care Watch blog for an on-line discussion of Picard’s article and the study it refers to.
August 29, 2014
Important Toronto Seniors Forum notice
Also, don’t miss the following advocacy messages.
Ageism Exists: Name it! Resist it!
May, 26 2014.
Dear Fellow Member of Care Watch
Below is a letter and package of material the Care Watch Board has sent out to all provincial candidates in both hard copy and electronic format. We are very concerned that during this election campaign there has been very little discussion of the increasing need for supportive home care services. Care Watch has been pursuing several avenues to turn up the volume on this issue. However, it is an uphill battle. We ask you to forward this to the people you are in contact with. Please also put a link to it and/or the Care Watch website http://carewatchtoronto.org /on your Facebook page.
The 2014 Provincial election is occurring as Ontario faces a number of challenges. How we address these will determine what kind of a society Ontario will be in the years ahead.
Frequently one hears concerns about issues that many people associate with population aging. Care Watch is an advocacy organization composed of Senior Citizens. Our sole purpose is to ensure that Senior Citizens receive the supports they need in order to sustain the quality of their lives as they age.
Attached are several short documents that outline key issues that are affecting supportive home care policies and programs in Ontario today:
Ø The rationale for implementing designated funding for supportive services;
Ø The impact of ageism on policies and programs;
Ø An election post card with questions that we are encouraging Senior Citizens to ask of all candidates during the campaign.
We are sending these materials to you to inform you of issues that are important to senior citizens — major voters in the upcoming election. For further information, please visit our website http://carewatchtoronto.org/ where we will be posting updates throughout the election period.
Finally, we welcome the opportunity to meet with you around issues affecting Senior Citizens.
For important resource information on what electoral candidates need to know about supportive home care services, please click here.
Care Watch’s Bea Levis, honoured with the Ontario Gerontology Association’s 2013 Positive Aging Award, shapes policy discourse on ageism and senior citizenship. Click here for the tribute.
Care Watch’s Charlotte Maher, posthumously awarded the Francis Lankin Community Service Award from Social Planning Toronto: Click here for the tribute.
Care Watch mourns the loss of its founder and leader, Charlotte Maher. A long-time social activist with a hunger for justice and the capacity to make a difference. We will miss her deeply, but will continue to follow her lead.
In The News
On Saturday October 6 2012 Sherri Torjman, Vice-President of the Caledon Institute of Social Policy, wrote an op-ed piece in the Toronto Star articulating some of the implications for home care as the Canadian population ages. She reiterates the well-known cost concerns that accompany most discussions of population aging. Home Care is usually proposed as one response because studies document that it is cost efficient and effective. Of course, these calculations do not include the costs that families bear (see Care Watch’s Pragmatic Proposal for a graphic presentation of these private costs). As more and more people embrace the idea of home care, how to finance it is seldom seriously considered. In this article Sherri points out that Canada has confined its use of social insurance to income security, while other countries have used it to finance home care. She also notes several other approaches that are in use. Importantly, she highlights that the funding issue has been addressed in other jurisdictions – it is not insolvable but it does require innovation and an active debate about alternatives. Care Watch, in our Pragmatic Proposal, raised very similar concerns. In the past year we have made numerous presentations to groups on the topic but have found that when it comes to debating new ways of funding home care people get nervous. Why are we so reluctant to consider options that have worked elsewhere? Thank you Sherri for raising this central home care issue in the media.
In response to: Aging with Dignity – Globe & Mail Editorial Sept. 9, 2012
“Care Watch also praises Susanna Lafarge for her generous gift to Mac Masters for the purpose of studying optimal aging. It holds promise for those of us who are aging and all the rest who will age. Care Watch has for many years promoted preventative options. Some of the innovative ideas described in the editorial are truly remarkable and perhaps life changing but, not for today.
The purpose Care Watch is to promote the development of early need, supportive home care which is easily assessable and consistent as has been shown empirically (Hollander and others) to reduce admission to hospital and long tern care, aiding optimal aging and economy. We have great trouble understanding why this piece of the puzzle is consistently missed by editorial writers and , indeed, the government”
- Charlotte Maher