On June 18, 2020, Warren (Smokey) Thomas, President of OPSEU, submitted the union’s brief on Bill 175, Connecting People to Home and Community Care Act, to the Standing Committee on the Legislative Assembly.
OPSEU’s Written Submission to the Standing Committee on the Legislative Assembly
Bill 175 – The Connecting People to Home and Community Care Act
About the Ontario Public Service Employees Union:
The Ontario Public Service Employees Union represents more than 165,000 workers in the Ontario Public Service, the Broader Public Service and the Colleges sector. Our members work in the public sector both provincially and municipally, for private contractors performing work for public entities, for the Ontario College of Trades, the College of Applied Arts and Technology, in public agencies like the Liquor Control Board of Ontario (LCBO), the Municipal Property Assessment Corporation, in hospitals and other health care providers, at universities and school boards, and in a wide range of social services.
List of Recommendations
- Recommendation 1: Completely withdraw this legislation and begin again with fulsome public stakeholder discussions.
- Recommendation 2: Directly fund and operate home care in Ontario to provide greater stability to the sector and increase quality of care.
- Recommendation 3: The government should not rely on an expansion of the direct funding model.
- Recommendation 4: The government must properly allocate funding for home and community care.
- Recommendation 5: Sections of Bill 175 that remove or relocate public interest protections and oversight to the regulations must be removed.
- Recommendation 6: Address the fundamental problems with Ontario Health and the Ontario Health Teams related to public democratic oversight and engage with health care stakeholders and labour organization to improve these systems.
When Bill 175, the Connecting People to Home and Community Care Act, was introduced in February healthcare stakeholders expressed immediate concerns about what appeared to be the government’s intention to ram through these changes with little feedback or input. This process was put on hold due to the global COVID-19 pandemic. The changes outlined in the Bill are concerning to OPSEU, which represents employees both in the LHINs who work in care coordination roles and as frontline community healthcare workers. OPSEU agrees that home and community care need reform, however, this bill does not provide the kind of changes OPSEU wants to see.
While the government’s proposal indicates it believes there will be greater efficiency if home care coordination responsibilities are given to the Ontario Health Teams or a not-for-profit entity, OPSEU is deeply concerned about the potential for even more private control over Ontario’s home care sector.
Recommendation 1: Completely withdraw this legislation and begin again with fulsome public stakeholder discussions.
This legislation is clearly written with private interests in mind. The government should hold a proper public consultation process on reforming home care. We provide some broad ideas in this document.
Context of aging population & need for home care in Ontario
Ontario’s population is expected to continue to rapidly age over the coming decades and greater health support will be needed. While multiple forms of health care need to be expanded and supported, such as capacity in hospitals and long- term care, home and community care fills a unique role. While this legislation aims to provide the adaptability to the sector needed to address the challenges of an aging population, OPSEU believes it does not properly address the underlying structural problems of worker precarity and fragmentation of services, and in fact it entrenches them further.
Work Conditions are Care Conditions
Research on the intersection of health care and labour emphasizes that the working conditions of healthcare workers are the conditions in which patients receive care. Workers in home and community care want to provide the highest quality care they can, but are limited by less than ideal working conditions. Due to a combination of under- funding and for-profit interests, wages and benefits in the sector are low, especially compared to what many could be making in similar positions in the hospital sector. Workers often have to travel large distances to provide care to patients in their homes and are poorly compensated for doing so.
In for-profit home care, workers are usually paid at a per-visit rate, rather than hourly. This means that home care workers are forced to squeeze in as many visits as they can in an hour just to make ends meet. This creates conditions where patients are unlikely to receive the amount of care they require, and workers are can’t provide the amount of care they would like to. This is a failure of underfunding and profit-driven home care.
Most recipients of home care do not have the same home care worker every visit, which undermines the consistency of care. In fact, because of the fragmented nature of the sector, many seniors will have different services provided by separate agencies, depending on which agency has been contracted for that particular service. Disturbingly, there is no case information sharing between agencies.
All the ‘efficiencies’ found in the sector are on the back of quality care and result in the further fragmentation of care. This legislation creates even greater tiering of accountability. Rather than ensuring proper oversight and responsibility for the sector, this government is attempting to further remove itself from its responsibility to the seniors of Ontario.
Bill 175: Connecting People to Home and Community Care Act
This legislation moves the care coordination function from the LHINs to a not-for-profit entity that provides home and community care. Shuffling care coordination from the CCACs to the LHINs didn’t solve the problems with home care. However, with this bill, the care coordination aspects of home care have again been moved to the new Home and Community Care Support Services (HCCSS). These new organizations will continue to exist for a few years while the Ontario Health Teams get rolled out, and then also be wound down. This is captured in Schedule 1 of Bill 175, under subsection 1 (5), which updates subsection 1(2) of the Connecting Care Act.
Redefinition of the new Home and Community Care Support Services
A not-for-profit entity that provides home and community care services.
While this redefinition is meant to capture the new Home and Community Care Support Services, we are concerned that private companies may get a foothold in the care coordination aspect of home and community care through the Ontario Health Teams. As we detail further below, the Ontario Health Teams can be made up of a mixture of public, private, non-profit, and for-profit interests, which we believe will result in increased privatization.
There doesn’t seem to be anything in this legislation preventing a for-profit home care service agency from creating a separate non-profit agency to act as a health service provider under this update subsection.
And because the Ontario Health Teams essentially make their own oversight processes, there’s little within the Ontario Health Teams preventing it.
As well, the process around timelines for this move are vague at best, similar to the timelines and information about how the Ontario Health Teams will actually function. OPSEU represents care coordination workers in the LHINs, and we are concerned about what this upheaval will mean for those members. If care coordination functions are moved to a different health service provider, or are provided by the Ontario Health Teams, what does this mean for those workers’ jobs or their collective agreements? If private entities are in charge of coordinating home and community care, we know they will seek efficiencies on the backs of frontline service. The labour relations implications of this legislation are staggering, and those most affected will be frontline workers and those receiving home and community care. OPSEU will be the first to say that the LHINs model and the previous CCAC model had serious limitations, mostly due to inadequate funding for frontline staff and an overabundance of upper level bureaucrats. However, the Ontario Health Teams model does not alleviate our concerns.
Recommendation 2: Directly fund and operate home care in Ontario to provide greater stability to the sector and increase quality of care
This is the model British Columbia is in the process of implementing, where the government announced that publicly- funded home care services would be put back into the public sector to be directly run by regional health authorities to improve scheduling, provide more stable hours, and make work less precarious. This will improve employee retention and recruitment. A publicly funded and operated home care system in Ontario would directly address inequities in the system as it would remove the profit motive. On the worker side, this would directly address the concerns detailed above regarding low wages and benefits and stability of work. On the patient side, this would drastically improve care, as pressures from for-profits to cut corners would no longer exist. Having a provincially-operated home care agency would also address the problems of case note sharing, as all case notes would be made by workers of the same provider.
This legislation adds subsection 21 (1.1) to the Connecting Care Act, which allows the health service provider in charge of funding contracts for home and community care services to provide individuals with funding directly to find and pay for these services on their own.
(1.1)The Agency may provide funding to a health service provider or Ontario Health Team for the purpose of the provider or Team providing funding to, or on behalf of, an individual to purchase home and community care services.
The inclusion of “providing funding to, or on behalf of, an individual” is deeply concerning. OPSEU rejects the Ontario government’s attempts to deepen an individualized system of receiving health care, especially in the realm of home care. The proposal in the regulations appears to heavily imply the government is expecting self-directed care to make up a larger portion of services moving forward. This self-directed funding would likely be used in cases where a Health Service Provider is unable to find a home care service provider to contract this work to, such as in rural or northern regions. Another concern OPSEU has is that it appears the individual Ontario Health Teams or designated Health Service Providers would be setting the terms and conditions of self-directed care funding, meaning there would likely be regional disparity in who was forced to use self-directed care. Patients would be forced to pay for home care services from a private for-profit, or would rely on even more informal types of care, such as paying family members or neighbours to provide this care.
Recommendation 3: The government should not rely on an expansion of the direct funding model
Forcing patients to find their own care is not about providing them choice, but rather is an abdication of responsibility on the part of the government. This type of funding will reinforce inequities in our health system, and make it difficult for underserved areas to access care.
Waitlists & Access
This legislation does little to actually improve access to home and community care. The regulations say the Ministry will remove service caps on home care, which is intended to free up home care resources so more patients can access them. However, as the Ontario Health Coalition has noted previously, this is relatively meaningless, as service is already essentially rationed due to severe underfunding. Those who are unable to access home care through publicly funded services due to long wait- lists or being deemed ineligible are forced to pay for services privately or go without.
Recommendation 4: The government must properly allocate funding for home and community care, rather than pretend like patients receiving too much service is the problem
The government began rushing this bill through the legislature in late February and early March and was only stopped by the global pandemic. OPSEU would like to point out Ontario is still in the middle of a pandemic, which seems like an inappropriate time to continue pushing this bill forward. As discussed above, this bill has the potential to massively destabilize the sector, which is the last thing needed during the COVID-19 pandemic.
We agree there needs to be a massive overhaul of home and community care, but the government needs to properly engage stakeholders before doing so. This includes patients, health care advocacy groups, and labour and professional organizations. Many of the protections and complaints processes that were in the Home Care and Community Services Act (1994) have been removed entirely or moved to regulations. Much of the decision-making power in this proposed legislation is also relegated to the regulations, which severely undermines democratic oversight, as significant decisions can be made without the input of the legislative process.
Recommendation 5: Sections of Bill 175 that remove or relocate public interest protections and oversight to the regulations must be removed
This sector needs greater oversight and protections.
The Ontario Health Teams
In the past, OPSEU has been vocal in its critiques of Ontario Health and the Ontario Health Teams model. Ontario Health is governed by a board from which most members come from private industry such as finance and for-profit long-term care.
It makes its own bylaws, is not required to have public meetings, and has inadequate public oversight. This legislation would give the Ontario Health Teams or non-profits as designated by those Ontario Health Teams the power to coordinate home care. This is deeply concerning. The Ontario Health Teams can be made up of various organizations, both public and private. They do not exist within predefined geographic boundaries, but rather choose their own boundaries when applying (potentially even overlapping with other OHTs or leaving large geographic gaps). It does not take much foresight to see that private interests will run amok here, and the home and community care sector will become even more chaotic and fragmented. With this legislation, public health dollars will go towards private dividends rather than being invested in our frontline health services.
Specifically, echoing our submission for the Connecting Care Act, OPSEU recommends the following: board members of Ontario Health be democratically elected and accountable to patients and communities; meetings are open to the public with ample notice, and; the government establish robust public consultation and accountability requirements.
Ultimately, this bill waters down public control over home and community care, and further removes it from the auspices of the government. Moving forward with this legislation in the midst of a pandemic is reckless. It limits an appraisal of the lessons learned and how they can be applied to reforming this system – the most important being the fundamental importance of publicly delivered health care. Home and community care workers are in highly precarious jobs with massive turnover, which this legislation does nothing to remedy. This legislation is being pushed through while people are distracted by the pandemic, and before an inquiry about long-term care can take place to expose the problems with for-profit interests running unchecked in health care. The end result of this legislation is not a more robust and nimble home and community care system – it’s a recipe for disaster.