Expect big changes to the home-care system: Gélinas

Big changes are coming to the way home and community care are handled in Ontario, says NDP health critic France Gélinas.

“I am 100-per-cent sure that changes are coming to the structure of the system,” said Gélinas, the MPP for Nickel Belt.

Her confidence stems from comments Ontario Health Minister Eric Hoskins made at a recent Ontario Hospital Association event in Toronto.

“Now the time has come for us to have a conversation about the structure of the system,” Hoskins told a large crowd of health professionals at the Nov. 4 event.

Gélinas said the push for systemic change has gotten stronger in the last few years amid a number of reports that have been critical of Ontario's 14 Community Care Access Centres (CCACs) in particular.

In September, a report from Ontario Auditor General Bonnie Lysk concluded the provincial government needs to take a “hard look” at how Ontario's CCACs, along with their third-party providers, deliver home- and community-based care.

The report found, for instance, that for the year ending March 31, 2014, 47 per cent of all patients across the 14 CCACs were not seen within 24 hours of their discharge from hospital.

While CCACs have said 92 per cent of their expenditures go directly to patient care, Lysk found that percentage falls to 72 per cent when a stricter definition of direct patient interactions is applied.

The percentage drops further, to 61 per cent, for actual in-person treatment of patients.

Gélinas said the auditor general will release a second report on home and community care to the public in early December, which she expects to be equally critical of the CCACs.

Gélinas said Hoskins has already seen the report and suspects his public embrace of systemic change might have been influenced by its contents.

The salaries of CCAC executives have also come under the fire in recent years.

The Ontario Nurses Association singled out North East CCAC CEO Richard Joly for his six-figure salary when union members at nine CCACs across the province were on strike in early 2015.

Why, the union asked, should Joly have received a pay increase totalling 64 per cent between 2008 and 2013 while the average registered nurse with the CCAC got just four per cent over a similar period? The average salary for a CCAC nurse is around $50,000 a year.

As a public sector worker, Joly's salary is public information. Reviewing the yearly Sunshine List of public sector workers making more than $100,000 a year between 2008 and 2013, NorthernLife.ca learned that — averaged out — Joly received a nearly 13-per-cent raise every year over those five years. In dollars, he made $122,210 more in 2013 than he did in 2008.

During that five-year period, Joly's position was renamed from executive director to CEO, after Ontario's CCAC boundaries were re-written and he became responsible for a much larger area of the province. His salary was also frozen at $248,000 in 2010 and 2011.

As for changes to the system, Joly told NorthernLife.ca it is difficult to speculate, but he agreed Hoskins has alluded to changes to home and community care.

“The structure is really secondary,” he said. “We have done these transformations before. We know how to transition and really manage change, and we will continue to do that from a patient's perspective.”

Joly said home and community care will remain a priority no matter how the delivery model changes.

Some health-care-sector insiders have suggested the province might disband the province's 14 CCACs and transfer their responsibilities to Ontario's Local Health Integration Networks (LHINs), which already cover the same geographic areas.

The Registered Nurses Association of Ontario recommended exactly that in a 2012 report on enhancing community care for Ontarians.

The association's model called for the home and community care system to be anchored in primary care.

“The people who know you best, in health and illness, are your primary care providers,” said Doris Grinspun, CEO of the Registered Nurses Association of Ontario, at the time.

Under the association's model, Ontario's 3,500 home and community care co-ordinators – primarily registered nurses employed by the 14 CCACs – would work more closely with family doctors, nurse practitioners and other primary care providers to co-ordinate home care for patients with chronic conditions.

Grinspun said if the LHIN's were responsible for both primary care and community care, they could allocate resources more effectively and relieve the province's health care budget.

In fact, the Registered Nurses Association of Ontario has estimated getting rid of the CCACs could save the province up to $500 million, that could be reinvested into direct patient care.