The Wynne government is getting into the business of providing home care directly, quietly creating a new provincial agency that could eventually serve hundreds of thousands of patients in Ontario, CBC News has learned.
The move would mean personal support workers (PSWs) become provincial employees. It also has the potential to take a significant portion of the $ 2.5 billion in annual publicly-funded home care away from the for-profit and not-for-profit agencies currently providing it.
The government says creating the agency would give home-care clients more choice in selecting a PSW and more control in determining their care schedule.
The move to increase public delivery of publicly-funded health services will likely be welcomed by some advocates who’ve been critical of Ontario relying on private-sector agencies to provide home care.
But some of those agencies who currently do the job argue it’s unnecessarily bureaucratic to create a government-run home-care provider. They also fear the move opens the door to the province taking over delivery of all publicly-funded home care, and are urging Health Minister Eric Hoskins to reconsider.
“We are really concerned that every dollar goes into better front-line home care for patients, and it should not go into directly funding the creation of another bureaucracy,” said Sue VanderBent, CEO of Home Care Ontario, representing 40 agencies that deliver nursing and PSW services.
“The government should stop the implementation,” said VanderBent in an interview with CBC News. “We believe it’s not too late to reverse this decision and really consult with us.”
Document reveals plan starts in spring
The plan is laid out in a Ministry of Health document obtained by CBC News. The 11-page presentation dated October 2017 says the agency called Personal Support Services Ontario will be created this fall and will start to deliver home care in the spring.
The document says this “new provincial agency” will “directly recruit, screen and employ PSWs.”
The plan is to begin using the agency in three of the province’s 14 local health integration networks (LHINs) in spring 2018, with the goal of full provincial roll-out by March 2021.
Contacted by CBC News, Health Ministry officials confirmed the plan is in the works. However, they said they could not yet indicate the size of the agency’s budget, how many clients it will serve or the number of PSWs it will employee.
Hoskins first mentioned the agency in passing as part of a bigger announcement in early October, and it was not widely reported. The government’s news release — primarily about an increase in publicly-funded home care services — gave no details beyond announcing “the establishment of a new personal support services organization in early 2018.”
The new information about the plan obtained by CBC News has many in the home-care sector concerned.
“I believe that they are trying to cut out the home care agencies completely,” said Miranda Ferrier, head of the Ontario Personal Support Worker Association, an advocacy group with 31,000 members.
“To be honest, I don’t know how this is going to work,” said Ferrier in an interview. “It’s going to be a difficult situation for Ontarians that are receiving the care and it’s going to be a difficult situation for personal support workers that are already in that sector.”
“We don’t understand why we have not been informed and consulted,” said VanderBent, describing the plan as “rushed.”
Some 729,000 people received provincially-funded home care services in 2015-16. Nearly all of that care was delivered by nurses and PSWs employed by outside agencies, both for-profit and not-for-profit.
The document says the new provincial agency would “initially” provide personal support workers to clients who need a high volume of home care, at least 14 hours per week.
How big will agency grow?
That word “initially” is what has Ferrier and VanderBent sounding the alarm.
“I don’t have any idea of how big it could get,” said VanderBent.
“How are they going to set up the structure so that it properly supports the PSWs and the clients?” asked Ferrier. “We don’t really know what’s going on because they’re not talking to us about it.”
“The government does not intend on having this agency deliver all publicly funded home care,” said a Health Ministry spokesperon in an email to CBC News. “The agency represents an alternative form of service delivery for personal support services in parallel to the existing system.”
In 2015, the auditor general criticized the regional agencies that co-ordinated home-care services, Community Care Access Centres (CCACs).
Bonnie Lysyk pointed to rising costs and discrepancies in services. She found nearly half of all clients were not seen within a day after being released from hospital, Lysyk questioned how much of the CCAC budget went into administration instead of home care and found that nurses employed directly by the CCACs were paid more than those employed by agencies.
Ferrier believes creating a new provincial agency to deliver home care amounts to reinventing the wheel and recreating a similar bureaucracy to the CCACs.