Struggling Home Care Systen stretched to the limit

Oct 22, 2007, Moira Welsh, Staff Reporter, Toronto Star
MP's calls unanswered as mother taken to ER

For two weeks, while a surgical wound in her stomach grew raw and infected, Ontario's home-care system overlooked 83-year-old Ho Sze Chow.

That her daughter is Toronto MP Olivia Chow and her son-in-law is federal NDP Leader Jack Layton – both of whom understand how to manoeuvre through bureaucracies – made no difference.

Scheduled nursing visits were repeatedly skipped. Phone calls and complaints went nowhere.

It was, Chow concluded, a cautionary tale for the 770,000 Ontarians – hospital patients sent home early, the disabled and seniors trying to remain in their homes – expected to use home-care services this year.

Home-care managers acknowledge the $1.68 billion program is stretched to the limit.

For Ho Sze, who had had a tube inserted through her stomach in August to release gall bladder bile, the two weeks of missed home-care appointments sent her back to the emergency ward in September. This happened despite her daughter's repeated calls to Toronto's Central Community Care Access Centre, which arranges home-care visits.

"If this can happen to me, as someone who has been in public service for 20 years, this can happen to anyone," said Chow, whose mother lives with her and Layton near College and Spadina.

Advocates, nurses and health-care academics agree the province's home-care system is stressed. Health Ministry figures show the number of clients has jumped 75 per cent over the past four years, while funding has risen 30 per cent.

Those interviewed say the problems include staffing shortages caused by shrinking wages, piecework instead of full-time jobs, growing workloads and less skilled, lower-paid support workers replacing nurses.

Anne Wojtak, of the Central CCAC, said privacy issues forbid her from discussing Chow's mother, but agreed that nursing shortages are affecting home care. "I do think they are stretched, yes," Wojtak said in an interview.

Some problems date back to 1997, when the Conservative government asked home-care providers to compete for contracts, awarding them to the lowest bidders rather than traditional providers. Non-profit organizations such as the Victoria Order of Nurses laid off nurses and personal support workers as for-profit companies successfully cut salaries and benefits to win contracts. Many nurses left, getting better wages and more security in hospitals and nursing homes.

"Nurses do not get paid the same, so a nurse in a hospital earns a different wage than a nurse in the home-care sector," said Wojtak. "That is a definite recruitment issue – especially when there is a shortage. ... So we do have trouble sometimes keeping nurses in the (home-care) community."

Lucy Morton, a registered practical nurse who works with the Victoria Order of Nurses in Hamilton, said that over the last year, some local agencies have been so short-staffed they have refused to take new referrals – even though they are required to do so.

Some health-care companies have cancelled visits to existing patients to take on new clients who need care more urgently, she added.

Wojtak said few complaints have been lodged with the Central CCAC, which was created Jan. 1 when the province amalgamated 42 Community Care Access Centres into the current 14. In the first nine months of the year, Wojtak said the Central CCAC has served 37,000 clients and received about 750 complaints.

Ontario-wide, the Ministry of Health reports there were 4,062 complaints in 2004-05 and 3,931 complaints in 2005-06. Complaints are not counted if initial grievances are resolved through meetings with CCAC managers.

Chow and others question the complaint numbers. Chow said few people would figure out how to file a complaint with the CCAC.

York University professor Pam Armstrong, an expert in home care, said many patients have no idea who to call within the system, so complaints are often directed to advocacy groups or researchers.

Since the Liberals came to power in 2003, they have sought to upgrade home care.

Under Health Minister George Smitherman, the lowest-paid home-care workers saw their minimum wage increase to $12.50 an hour from $9.65.

During the recent provincial campaign, Smitherman promised $700 million for a three-year plan that would help older people remain in their homes. The details were vague, however, with the ministry saying only that money would go to expand a mix of services (including home care) that would allow seniors to live "with dignity."

The changes weren't enough to help Olivia Chow, who said she doesn't know why a nurse from privately owned Spectrum Health Care did not appear for scheduled visits following Sept. 7.

Chow finally gave up on the CCAC and called an emergency ward doctor at Mount Sinai Hospital. On Sept. 23, Chow rushed her mother to the emergency department with a high fever. Ho Sze has recovered. But Chow remains distressed by the lack of communication from the CCAC.

She said she's not trying to make a political point with her mother's case, which she first discussed with a reporter in September, but did not want to talk about publicly until after the provincial election.

Lori Lord, Spectrum Health Care's chief operating officer, said patient confidentiality prevented her from discussing Ho Sze's case. "We certainly are aware of the incident and at Spectrum Health Care this type of incident is very rare, but regrettable," she said. "We have launched our investigative processes and our internal procedures and policies regarding this matter."

Community Care Access Centres explained
What they are
Fourteen regional centres - five of which operate in at least part of the GTA - overseeing government-funded home care and long-term care centres across the province. They each contract out nursing services to several for-profit and non-profit agencies based on bids.

Who uses it
Hospital patients who have been sent home and need additional care, seniors who need help so they can continue living at home and the disabled.

Main services
Nursing, personal support (help with bathing, dressing, etc.), physiotherapy, occupational therapy, speech-language therapy, social work, nutritional counselling, medical supplies and equipment.

Wages
According to the Ontario Nurses' Association, a registered nurse in home care earns between $20.65 and $33 an hour. In a hospital, an RN earns between $26.80 and $38.07. Lower-paid registered practical nurses and personal support workers are also used, with the minimum wage for support workers set at $12.50 an hour.

How it works
Anyone can make a referral to a CCAC - a family member, caregiver, friend, physician, etc. A CCAC case manager determines and arranges care.