The Champlain CCAC continues to lurch from crisis to crisis.
Is it time
for the province to intervene — again?
“It’s a question of how we can do work more efficiently and maybe less
people.” – Patrice Connolly, vice-president of people and stakeholder
engagement, Champlain CCAC.
The Ottawa Sun is reporting the Champlain CCAC has cut services
to a patient who has multiple sclerosis and cannot bathe, dress, or cook.
Without his visits he cannot also do the exercises needed to keep him from
stiffening up.
Over the summer Champlain realized that it was headed for a $6.8 million
operating deficit and reset the threshold for personal support services to an assessment
score (RAI) of 15.5 – this on a scale that goes to 28.
Further, staff have been told to instruct patients in need of care how
to access other services, “many of which have a co-pay fee.”
States the Champlain CCAC in their June minutes: “staff recognize this
is a hardship for clients and families, however the Champlain CCAC must also
work within the budget it is provided.”
Oh, and if your condition changes, says the CCAC, give us a call.
This is not about efficiency. The CCAC is not doing anything better or
more effective with the same amount of money or less, it is simply rationing
services and shedding patients in need.
In fact, a brief look at their quality indicators would suggest the CCAC
is failing in several of their categories to be more “effective.” Their goal to
reduce adult long-stay home care clients who record a fall between assessments
has gone in the opposite direction – it has gone up substantially. Their target
to increase the percentage of complex patients who receive their first personal
support service within five days is still well below the goal of 90 per cent.
In April it was 80 per cent, and in July 82 per cent.
Not surprisingly, by September the budget problems were even worse. For
the first four months of the year the CCAC sustained a deficit of $5.3 million
– that’s $3.2 million over what they had “planned” for the same period of time.
Unless the CCAC can stem the red ink, they are now on track for a deficit
closer to $16 million.
The Sun reports the CCAC is witnessing a widening gap between
funding and demand. Funding is going up by 7 per cent with the promise of
another 1.5 per cent to come. However, demand has increased by 11.3 per cent.
Given Ontario hospitals have been staring at zero-base budgeting for
several years now, what did they expect?
Home care was supposed to reassure us that hospital cuts simply
represented health care reform, that we shouldn’t worry, people could receive
care where they wanted it: in their home.
In addition to multiple sclerosis that confines him to a scooter, the
patient denied service by the Champlain CCAC also has cancer behind the eye,
diabetes and a severe thyroid condition.
It’s true that less people includes the shedding of some of the
top-heavy management at the CCAC. It also means shedding other jobs that
directly interact with patients. We’re not sure how you care for patients like
this with “less people.” If he can’t get care, who can?
Care Coordinators are beside themselves as they are forced to tell
long-service clients that they can no longer access care.
Champlain is in free fall and the government needs to step in to protect
the health care of patients who absolutely need service from the CCAC.
It wouldn’t be the first time. Prior to amalgamation of CCACs within the
Champlain region, Ontario appointed a new Chair to take over the Ottawa CCAC in
2004 after a scathing operational review. Since amalgamation the Champlain CCAC
has run through a number of CEOs as it lurches from what some describe as
crisis-to-crisis.
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CCACs
could play expanded role as direct home care providers
Doris Grinspun, the executive director of the Registered Nurses
Association of Ontario (RNAO) has been a tireless defender of public
not-for-profit health care. We’ve seen her speak truth to power at numerous
conferences and public events. When she advocates on behalf of the RNAO, she
speaks plainly and passionately.
Last month the RNAO released its submission to the government on
Ontario’s seniors care strategy.
The document is full of good recommendations, from strong staffing
standards in long-term care homes to a broadening of the policy lens to include
government’s impact on the social determinants of health.
The biggest surprise, coming out during the same month as the Hudak
health care platform, is the RNAO’s recommendation that the Community Care
Access Centres be scrapped and the work be redistributed to the Local Health
Integration Networks and to primary care providers, such as family health
teams, community health centres and nurse practitioner-led clinics.
Unlike the Tory platform, which cuts both the CCACs and the
LHINs loose and hands over local decision-making to large unaccountable
“hub” hospitals, the RNAO splits the role of the CCAC into two. The
planning, contracting and monitoring of home care migrates to the LHINs, the
system navigation and assessment becomes the work of primary care providers.
The RNAO argues that it cuts out duplication and better integrates
the system, yet having the navigation function carried out by hundreds of
primary care providers rather than 14 CCACs suggests less overall system
coordination. It also raises questions about primary care providers that are
not in team practice.
Persistently long waits would also make it interesting as hundreds of
primary care providers try to advocate for their patients in a newly crowded
placement field.
While the RNAO says there will be substantial cost savings – the
CCACs account for about $2 billion of the province’s $47 billion health
care budget – there is no real costing on how this would work, especially when
the RNAO sees the 3,000 CCAC case managers migrating to primary care,
a continuation of contract-based home care delivery, and an unspoken
enhancement of LHIN resources to accommodate new functions.
A few years ago the LHINs were miffed to be asked to provide oversight
on capital projects with no new resources. Clearly they couldn’t take this
additional role on without a substantial boost in their funding.
The CCACs at one time pitched themselves as system navigators,
yet their role was never expanded beyond home care and long-term care.
When the government gave the LHINs – not the CCACs – the reins of the
aging at home strategy, there was clearly an opportunity lost to stake out a
significant role within community care.
It’s not like the LHINs did a stellar job with this money, and the
issue was further clouded when then Health Minister David Caplan suddenly
required half this money be applied to dealing with the newly manufactured
alternative level of care problem.
The end of competitive bidding does present an opportunity – to migrate
front line care staff directly to the CCAC. Not only would it reduce the cost
of administering dozens of home care contracts, many with private for-profit
agencies, but it would make the CCACs much more nimble in addressing community
need.
When The Ottawa Hospital briefly took over the Champlain CCAC after
a series of scandals, staff reported to us that the new administrator was
frustrated by the fact that he simply couldn’t go out and hire the wound care
nurses the CCAC needed. By breaking the ban on new direct care staff at
the CCAC, the situation could be very different.
The flaw in the RNAO plan is there is no place to build direct
public not-for-profit front line care. Nor does RNAO address the existing
CCAC direct health providers – most who would be therapists – who never got
contracted out either because of high cost or lack of credible bidders in the
local community.
RNAO complains that the CCACs have high administrative costs,
especially when compared to the LHINs. This is a bit unfair. Competitive
bidding and contract management itself created significant administrative
burdens on the CCACs – an issue we have repeatedly pointed to. A system
that migrated to more direct publicly provided care would reduce such burden
and increase continuity of care (see our story on the two physiotherapists).
The RNAO says the LHINs have low administrative costs relative
to their budgets, but this is largely because most of the money in that budget
is simply flow-through from the province to large providers, such as community
hospitals. This does not mean that the hospitals and other funding recipients
don’t have their own layer of administration – much of it essential in this new
world of metric-driven health care. It’s true that the LHINs have been
encouraged to be more proactive in redistributing funding, but it’s hard to believe
that after adopting a new hospital funding formula the province would sit by
and watch the LHINs redistribute this money based on alternate criteria.
The RNAO also risks adding fuel to the fire over the Tory
proposals, which are far more political than pragmatic. The Tories play on the
public’s lack of knowledge of the work done by the LHINs and the CCACs.
The end of competitive bidding provides a new opportunity to look again
at opportunities in home care. Rather than simply mess about with market share
among existing providers, it would be good for progressive groups to look at
publicly provided care models, including those that already exist in other
provinces. To do that, it may be a bit premature to throw out the CCACs.
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As a postcript to this, the RNAO have asked us to wait and see their
full proposal on this issue before coming to any final conclusions. The report
is due out soon. We look forward to it.
