Tory government cuts to home care funding threaten to change the face
of community health care right across the province. Privatization has
created an environment of service reductions, staffing shortages and lower
standards. How did this happen? Here is a brief history of how the
Hamilton-Wentworth Victorian Order of Nurses (VON) has tried to save
quality home care in our area.
In 1997 the government created the Community Care Access Centre (CCAC).
The CCAC is responsible for contracting out community health care services
through a managed competition process. Service agencies received a Request
for Proposal (RFP) in 1998 for the delivery of Home Nursing services in
the downtown core (about 25% of the region’s home nursing care
requirements). The CCAC disqualified VON from entering the competition
citing incomplete documentation. This remains a controversial issue for
staff at VON. In a news release October 10, 1998, the CCAC reported they
anticipated "savings of $500,000 a year following the awarding of its
first contracts for in-home nursing and personal support services" to
a for-profit agency. This was the first time a for-profit agency was
awarded part of that contract.
VON was successful in the next competition in 1999. It was awarded
approximately 67% of the remaining in-home nursing service. The CCAC said
"the process bases 75% of its scoring on the agency’s ability to
deliver high quality service and 25% of the total scoring deals with the
cost." In other words, an agency may have the highest quality of
service but may lose the contract if it fails to bid at a competitive
cost. The difficulty arises when 85 to 90% of community agency expenses
are used for wages and benefits, which is necessary to attract and retain
experienced, dedicated staff. The CCAC had to know that competitive
pricing would have an adverse effect on the front line workers, creating
unmanageable caseloads and lowering standards of client care.
Had the VON not been successful in the 1999 competition it would have
had to close its visiting nursing program. We were told that if the VON
was to survive, we would need to deliver nursing service "faster,
better and cheaper". Our collective agreement had expired in
March, 1998. On July 1, 1999, we narrowly ratified a one-year contract which expired
March 31, 2000. We agreed to concessions in weekend and stat holiday
scheduling, and to an increase in the number of clients we would visit
each day. The number of clients we visited would be directly linked to the
amount of mileage we would be paid. We thought we could manage the
workload given that the collective agreement would only be in effect for
eight months, and we agreed to try. We were desperate to keep our agency
alive and to continue in community nursing. Most of our nurses would
rather leave community care than to work for another agency, especially a
for-profit agency.
After 13 months of trying to deliver quality nursing care under the
budgetary constraints of the managed competition process, we can no longer
do it. The VON’s contract with the CCAC expires March 31, 2002. The VON
says it will cannot increase in wages or change scheduling until that time
and even then, only if the CCAC increases funding. Our nurses are
now seeing 10 to 12 clients a day, sometimes more. VON nurses and staff
have not had a wage increase in 10 years and community nurses’ salaries
have dropped 15 to 30 per cent below hospital nurses.
As a result, many of our nurses are leaving the community. Those who
remain are continually asked to work overtime and extra weekends to
compensate for staff shortages. Because of concern for their clients, our
nurses feel guilty if they do not perform the extra work. Even though they
are exhausted, they know there is no one else to make the visit. This
summer, every agency in the Hamilton-Wentworth region has at one time or
another placed itself on referral by-pass. This means that patients who
could be discharged must remain in hospital because there is no community
nurse available to assist them. Every community care agency is facing a
staffing crisis as they can no longer attract or retain staff.
It was a gut-wrenching decision for VON staff to vote for a strike. The
95% vote in favor of strike is not just about our wages or our
agency. We are sounding the alarm that if the wages, benefits, and the
workload of community workers does not improve there will be no one left
to provide care should you, your family or your friends need it. This
strike vote is a desperate plea to the Conservative government to improve
funding for community nursing. We must ensure there is adequate staff to
provide home care. Hospitals discharge patients quicker and sicker then
ever before and the resources and staff must be available to care for
these patients in their homes. The nurses and staff at the VON want you
know that this decision was not made easily. We feel we have no choice.
We believe that other agencies will not speak openly and publicly about
the community staffing crisis for fear of losing their contracts with the
CCAC. The CCAC is a government agency and their "managed
competition" process introduced privatized home care in this
province. The CCAC said they saved $500,000 when they contracted the first
25% of community care. Where has that money been redirected? How much did
the CCAC save when they contracted the remaining 75%?
The CCAC has acknowledged that the government needs to provide more
funding for home care. The CCAC is responsible for the contracting of
service providers to deliver quality home care and it is now time
they acted responsibly by ensuring the funds are available.
VON also manages Meals on Wheels, Volunteer Visitors, Foot Care
Clinics, and the Adult Day Centre on Victoria Avenue North. These services
will also be hurt if we go on strike at midnight August 30. It is now in
the hands of the CCAC and the Conservative government. We have great
concern for all our clients and sincerely hope that this strike can be
averted. Please believe that because of our concern for you and the
quality of the care we know you deserve, we are forced to take this
position.
We all deserve better!
Better wages for front line workers in this community, better quality
of service for our clients. No patient should ever have to stay in
hospital longer than necessary because we don’t have a community worker
to assist them. This strike is not about more wages for us; it’s about
better service for you.
Lois Boggs
President OPSEU Local 269
Victorian Order of Nurses
Hamilton-Wentworth Branch
