Caplan Review
Home Care/ LHINs

McGuinty Liberals backtracking on promise to provide continuity of home care

Will Eleanor Caplan create a blueprint for privatization of the health care system?

The Romanow Report called home care the “next essential service.” Yet the Harris Tory government created a home care system in Ontario that is increasingly private, for-profit, low-wage, part-time and erratic.

That’s why home care workers were optimistic that the McGuinty Liberals would do something to replace the “competitive bidding” system that is playing havoc with the way home care is delivered in the province.

The system selects home care providers through a contracting process. Every three to five years, home care services are put up for tender by each of the 43 Community Care Access Centres. When this results in a change of service providers, patients are often stripped of their existing home care workers they have come to trust.

Faced with angry patients and home care providers, Ontario Health Minister George Smitherman agreed Sept. 9 to conduct a review of the process. “We will work to create a home care system where a greater premium is placed on continuity of care,” he said.

"There are significant concerns that the scale of contract changeovers is causing instability in the home care labour force and in the homes of patients,” he repeated Oct. 4, when appointing Elinor Caplan, a former Ontario health minister, to conduct the review.

Competitive bidding was creating huge turnovers in staffing that affected continuity of care. Yet despite this, Smitherman set a proviso for the review: The competitive bidding process must remain.

It was clear how Caplan saw her task: "This client-centred review will ensure we are getting the very best quality for patients, the very best price for taxpayers and a fair and equitable process for providers."

Apparently, workers and continuity of care no longer fit in to the equation. Despite the earlier statements by Smitherman that the process put “disproportionate premium on the lowest cost bid,” cost was front and center in a review that was supposed to be about continuity of care.

Susan Vanderbent, Executive Director of the Ontario Home Health Care Providers Association, a group dominated by for-profit companies, echoed the shift in emphasis: "OHHCPA members are supportive of the RFP (bidding) review and need for an open, transparent and fair purchasing process that can deliver the best quality care to home care clients at a responsible cost to the public."

Early meetings with Caplan suggest she has little interest in the actual delivery of quality home care. Instead, she regards her mandate strictly as setting the rules for the competitive bidding process.

Despite its potential impact on patients, her review is taking place largely behind closed doors. She says the public is invited to attend some of the meetings, but the meetings are poorly publicized and there is no informational web site.

Caplan has also chosen to stage many of her meetings at the CCAC offices, which is not “neutral ground” for many former home care workers. Nurses in Niagara felt so uncomfortable about blowing the whistle on the conduct of their CCAC, they rented a room at a nearby library in order to meet separately with her.

A blueprint for privatized health care?

The question remains: Did Smitherman announce this review to address the problems of home care contracts, or did he do it as a means to create a blueprint to open the rest of the health care system to increased for-profit delivery?

Caplan says that her recommended model of competitive bidding would likely be a feature of the new Local Health Integration Networks (LHINs), the McGuinty Liberals’ new umbrella organizations that will run all health care services across the province.

Here are some of the views she has expressed in meetings so far:

· Caplan dismissed “successor rights” – the right of employees to follow their clients to a new company --as out of her review’s jurisdiction.

· She views lack of pensions as the biggest problem facing employees – not the prospect of ever diminishing wages and benefits or the complete loss of their work when a contract changes hands.

· Caplan says she is looking at the idea of a provincially-administered “prequalification process” for home care bidders. She obviously sees no problem with spending even more money on the bureaucracy surrounding the bidding process -- money that could be better spent providing direct care.

Impact on quality home care

Home care services aim to keep patients in their homes and out of more expensive hospitals and long-term care homes.

Services include nursing care, occupational therapy, physiotherapy, social work and support services, such as homemaking. When a home care agency loses a contract to another agency through this process, the front line workers lose their jobs and are often forced to reapply to do the same work at the winning agency minus their union contract, their seniority, their pension and often for lower wages and benefits.

It’s become a race to the bottom and many skilled professionals are leaving the field. The result is a growing shortage of home care workers at a time when they are most needed.

Home care is the battleground against for-profit privatization that threatens to destabilize the entire health care system.

It’s clearly time to end the competitive bidding process and ensure a stable, well-funded home care system. The result will be less reliance on the hospital system and a continuity of patient care delivered by a proud and stable contingent of home care providers.

Elinor Caplan needs to hear from you! Speak out! You can arrange your own appointment to speak to Caplan by calling Rheta Fanizza at 416-212-7687.

E-mail Submissions to the Caplan Review can also be sent via janet.clarke@moh.gov.on.ca

 

Press Release: http://www.opseu.org/news/Press2004/nov1a2004.htm