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“If we begin to look at health care as a commodity to be
auctioned off to the lowest bidder, we’re looking at a reduction in the
quality of services. That’s what we’re beginning to experience today in
Ontario.”
- Dalton McGuinty, speaking at a rally in
support of the Windsor VON, August 25, 1999
The Issue:
What will you do when I'm
gone?
Wasteful bidding process drives health professionals out of
home care
Nurses, therapists, and other health
professionals are leaving home care at a time when they are
needed more than ever.
Despite an on-and-off again moratorium since
2004, the Minister of Health says that the process which has
destabilized the home care workforce is returning.
Competitive bidding puts the patients of home
care health professionals up for auction.
When a home care agency loses that auction, the
care providers lose their jobs and the patients lose their
continuity of care. If the care provider is hired by the new
employer, it is often at a lower wage, with fewer benefits, and
without a pension plan. The workers also lose their seniority,
taking them back to a starting wage, fewer weeks of paid
vacation, and loss of other benefits associated with long
service. The workers also lose the kind of protections they
received while under a union contract. Is it any wonder
professionals are leaving the sector?
For patients, it means losing long-time care
providers who understand their health conditions. The
relationship between the care provider and the patient is often
a very personal one. These workers perform their duties in
patient homes often surrounded by family pictures and other
mementos of a lifetime. Often spouses and other family members
are part of the visit. In the competitive system, new workers
are often pressured to get in and out faster without ever
getting to know that client – sometimes to the detriment of the
patient’s health.
The government has been tinkering with the
bidding process for six years now without recognizing that the
fundamental problem is stability for workers and their patients.
When a business is normally sold, the workers do
not have to go begging for their jobs. Under Ontario law, the
workers have a right to continue on with their employment
conditions intact. This is not the case for home care health
professionals.
The bidding process is also wasteful. Each
contract requires substantial investment on the part of the
bidding agencies to enter into the competition. These detailed
submissions need to be evaluated by a team from the Community
Care Access Centre. Site visits need to take place. An award has
to be made, and the new contract monitored.
Case managers work for the CCACs – not the
agencies that employ the nurses, therapists and personal support
workers – meaning a less collaborative and team-based focus on
care. And with agencies competing with one another, there is an
incentive NOT to share best practices, less another agency is
given an advantage in the next competition.
This is a bad process.
It is no surprise that Ontario is the only
province to handle home care entirely this way.
With hospitals being pressured to empty
longer-term patients and open up beds, we need quality home care
to be there for Ontarians who need it now.
In the next election, ask your candidates about
this issue. Ask them what will THEY do when these health care
professionals are gone?
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