At last, Ontario Health Minister Eric Hoskins seems to get it.
After nearly a year of insisting Ontario’s much-criticized home-care system is performing just fine, Hoskins is now admitting the system is an utter mess and in desperate need of fixing.
Hoskins made the concession last week in unveiling a 10-point “road map” to improve home- and community-care delivery across Ontario. The program is a small, first step in the right direction, but lacks real details and falls far short of what is required to reform a system in such disarray.
The most important step was taken by Hoskins when he adopted a new attitude toward home care, a key part of the overall health-care system that has suffered for years from severe underfunding, political neglect and too much bureaucracy.
Indeed, Hoskins could actually become the new home-care champion.
That’s because home care needs a leader who cares deeply about a system that for too long has seen patients struggle to receive basic services they deserve, suffer when their therapy sessions or personal support visits are cut off or reduced, or who are sent home from hospitals with false promises of services to come to their door.
“We know from the feedback that we have received from literally thousands of individuals and families that the care that they are currently receiving is patchy, uneven and fragmented,” Hoskins admitted last week.
It was just six months ago that Hoskins was refusing even to acknowledge that any patients had their services terminated or reduced because of cutbacks by Community Care Access Centres, which oversee home- and community-care services. In fact, those cuts affected thousand of sick and elderly patients across the province.
Encouragingly, Hoskins unveiled several new measures last week that potentially could help patients receive better and more cost-efficient care.
One pilot program would give patients money to hire their own home-care services and health professionals to provide care in their homes. For example, hospitals might be able to work with discharged patients in regards to co-ordinating community supports. Ultimately that could spell the demise of CCACs, which now co-ordinate community care, usually through private companies and non-profit organizations.
As good as such steps are, Hoskins could have done so much more to truly improve home care.
First, Hoskins should radically reform the overall bureaucratic structure of home and community care. Gail Donner, former dean of nursing at the University of Toronto who headed a recent government-appointed panel on home care, has called the issue of structure “the elephant in the room” when it comes to poor delivery and coordination of services to patients.
The most obvious starting point is the 14 CCACs across Ontario. These government agencies, which are filled with many hard-working and dedicated staffers, have been rightly criticized as being too bureaucratic, inefficient and top heavy with high-paid executives.
Hoskins said last week he will wait until Auditor General Bonnie Lysyk releases two reports on CCACs before making any moves. The first report looking into CCACs’ financial operations, which was requested by an Ontario all-party legislative committee in March 2014, was to have been ready this spring. It now won’t be ready until late fall. The second report, which will look into other aspects of home care, will be included in the auditor’s annual report, tentatively set for early December.
Second, Hoskins should demand more money for rehab services, such as physiotherapy and speech-language pathology.
This growing area of need has been effectively gutted over the years in the name of cost-saving, with patients getting as few as two visits from front-line health professionals after being sent home from hospitals. At the same time, hospitals have closed in-patient and outpatient rehab clinics, forcing patients to fight for limited home-care services or pay privately.
Third, Hoskins should reverse a unilateral decision by CCACs that forbids charitable non-profit home-care organizations to fundraise among former clients.
Such a move would open the door for not-for-profit organizations to provide vital home-care services that are not now being met or are being under-delivered by CCACs. Low-income and aboriginal groups would be among those most likely to benefit from such a move. If non-profit hospitals can fundraise among former patients, it seems logical that not-for-profit home-care organizations should be allowed to do the same thing.
Home-care patients can draw some encouragement from Hoskins’ small steps forward.
But now is the time for bolder steps that will make a real difference in the lives of patients and caregivers around the province.