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Home care bill will enrich private companies, create conflicts of interest, advocates warn

'Quash it, quash it,' the raging grannies sing in a protest song against the Ford government's home-care bill
The Ottawa Raging Grannies sing a protest song against Ontario's Bill 135.

EDITOR’S NOTE: A version of this article originally appeared on The Trillium, a new Village Media website devoted to covering provincial politics at Queen’s Park.

The Ford government's plan to reorganize the home-care system will enrich the province's for-profit providers and leave Ontarians struggling with a "fractured and chaotic system," advocates are warning.

Health Minister Sylvia Jones tabled a bill in early October that would amalgamate the province's Health Integration Networks (LHINs) into a new organization called "Ontario Health atHome." The government's goal is that, in the future, Ontario Health atHome will delegate the responsibility for co-ordinating and providing home care to the province's Ontario Health Teams (OHTs) — 58 different groups of health-care providers.

Committee hearings on Bill 135, the Convenient Care at Home Act, were held this week and several stakeholders asked the government to toss it out.

"Bill 135 would create conflict between the financial interests of service providers and the health care needs of the home-care clients they serve," warned the Advocacy Centre for the Elderly (ACE), a non-profit legal clinic.

The group's lawyers warned that giving OHTs responsibility for home care will be giving the large private companies control over it, as home care companies are members of the teams.

"Under this model, health service providers will become responsible for the care coordination and engagement of publicly funded home care services," they wrote in a submission to the committee. "Health service providers have a vital and inherent self-interest in the financial viability and profitability of their services and operations. Home care clients have a different and competing interest in receiving home care services that meet their health care needs."

A spokesperson for Jones denied there will be a conflict because the responsibility for home-care will be "embedded into OHTs and not given to the providers themselves."

One of the problems, according to the advocates, is that OHTs do not have any formal legal structure — so the distinction is neither clear nor guaranteed. 

"They are loosely based collaborations of for-profit and not-for-profit health-service providers. They are not required to have any particular corporate structure — nor, in fact, any corporate structure at all," ACE wrote. "There is no legally required process for the internal governance, oversight, operations and legal liabilities or other responsibilities of Ontario Health Teams."

The group's concerns about this conflict of interest are more than theoretical. The legal clinic is frequently called on to help people who are struggling to get the home care that they need and that they're entitled to today, it said. 

"Through decades of experience serving community-dwelling older adults, ACE has witnessed countless occasions where service providers are reluctant to serve sometimes demanding and difficult to serve clients, even to the point of the outright refusal of service," ACE wrote."It is our experience that service providers would much prefer to cherry-pick the easier to serve consumers of home care services, and to limit access to their services by difficult or demanding clients as much as is legally possible."

Downloading home care to OHTs "creates the opportunity and incentive for care co-ordination services to focus on the ease of delivery and maximization of profits for the service delivery agents to the detriment of the client."

The result, ACE predicts, will be to drive more complex patients into the already overburdened long-term care system.

ACE wasn't the only group warning about the enriching of large private home-care companies and the further privatization of home care. Union groups, the Ontario Health Coalition and individual citizens raised the same concerns.

So did Ottawa's raging grannies, in their own unique way.

Getting rid of the province's 14 LHINs has been a long-held goal of the Ontario Progressive Conservatives. The goal of the regulation is to reduce a layer of bureaucracy in what's long been seen as a dysfunctional system, where some tasks in the co-ordination of home-care are duplicated by both the service provider and the LHIN responsible, a criticism levied by unions and home-care providers alike.

In 2019, then-health minister Christine Elliott announced plans to create the new centralized Ontario Health agency along with local groups of health-care providers dubbed Ontario Health Teams. The plan was to phase out LHINs when the OHTs were mature enough to absorb their responsibilities, primarily home care. 

Jones' bill takes that next step. According to a government press release, the aim is for the province to make Ontario Health Teams "responsible for connecting people to home care services starting in 2025," starting with a group of 12 OHTs have "been chosen to accelerate their work to deliver home care in their local communities starting" that year.

"With support from the Ministry of Health and Ontario Health, these teams will start by focusing on seamlessly transitioning people experiencing chronic disease through their primary care, hospital, and home and community care needs," the Ministry of Health's website says. 

The provincial government has approved 57 out of 58 Ontario Health Teams in the province and is providing each with $2.2 million over three years "to better co-ordinate people’s care," the release says.

One of the longstanding criticisms of the LHIN system is that the boundaries between them create a problem — when people move, or receive health care in another region, information gets lost or duplicated.

Some of the witnesses who spoke to the committee about Bill 135 warned that problem will worsen when 58 different groups — rather than 14 — are responsible for home care.

Jones' spokesperson, Hannah Jensen, said that, unlike LHINs, OHTS are "patient networks and will further integrate care."

However, most OHTs are regional in nature and the government's goal is that they strengthen the connection between health-care providers in local communities. When ask how the OHTs will handle situations where patients move, Jensen replied that "this level of detail would be determined through regulations or other directives."

Jones herself has not yet spoken to the committee about her bill. Testimony by the minister and top bureaucrats she oversees was cancelled this week and rescheduled for next Tuesday.

Another oft-repeated comment at the committee was that the bill doesn't do anything to solve the foremost problem in home care: there isn't enough of it because there aren't enough personal support workers and nurses working in home care.

"We ought to be hiring more nurses," sang the raging grannies to the tune of "My Bonnie Lies Over the Ocean" in their submission to the committee. "We ought to be paying them more. And home care needs many more workers, not less regulation but more.

"Quash it! Quash it! Bill 135 is an evil thing. Quash it! Quash it! Doug Ford must not be the king."


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Jessica Smith Cross

About the Author: Jessica Smith Cross

Reporting for Metro newspapers in five Canadian cities, as well as for CTV, the Guelph Mercury and the Turtle Island News. She made the leap to political journalism in 2016...
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