“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
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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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