Health Minister George Smitherman shouldn't try to fix the competitive bidding system in home care - he should scrap it, says the Ontario Public Service Employees Union (OPSEU).
The union representing home care workers was reacting to Elinor Caplan's report on what ails the system. But her mandate and recommendations fall far short of what's needed to sustain a viable service for patients and staff.
"Elinor Caplan wants to prop up Ontario's home care sector with rusty nails and two-by-fours," said OPSEU President Leah Casselman. "Unfortunately, the underlying problem lies with the foundation.
"The minister owes it to Ontarians to look for a better model that will provide long term sustainability to the sector," she said.
The present system has cost taxpayers millions, yet has failed to show any benefit. OPSEU told Caplan that competitive bidding creates a constant turnover of home care providers that has chased respected not-for-profit agencies like the Victorian Order of Nurses and the Red Cross out of many regions. It has displaced nurses,
personal care workers, therapists, and social workers - driving many skilled workers out of healthcare, creating staff shortages and interupting care for many patients.
While Caplan recommends an option for longer-term contracts, workers still face the prospect of scrambling from one employer to another as contracts result in changes of agency.
OPSEU says there is a much simpler and cheaper way to provide stable employment and continuity of care: Legislate successor rights to workers who are shuttled from one employer to another. Successor rights would allow workers to take their collective agreement from one provider to the next.
"Instead, Caplan recommends a new set of rules that will create more paperwork than front-line care. That's a shame. Ontarians deserve better," said Casselman.
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For more information:
Rick Janson, OPSEU Communications: 416-443-8888 ext 8207 or 1-800-268-7376
Last fall, the McGuinty Government appointed former Ontario Health Minister Elinor Caplan to undertake a review of the competitive bidding procurement process used by CCACs. The review followed after several long-time community-based home care agencies were ousted in favour of organizations with no ties to their respective
regions.
- In Niagara, as the community publicly celebrated the 85th anniversary of the local branch of the Victorian Order of Nurses, the Niagara CCAC took away their major home care contract amid a storm of controversy and protest. Most of the nursing staff had to be laid off.
- In Ottawa, most of the existing therapists refused to take a 30 per cent pay cut to migrate to the winning bidder of a competition, resulting in staffing shortages and long waits for the public.
- In Wellington-Dufferin, the local VON was forced into bankruptcy after losing their home care contract. Former staff members are still fighting to receive their final pay.
As community after community faced contract changeover, many frail and elderly home care patients found themselves facing uncertainty in other communities such as Kingston, Brampton and East York.
CCAC Procurement Review began Nov. 1, 2004
The CCAC Procurement Review officially began Nov. 1, 2004. While new competitions were frozen, competitions underway were allowed to continue.
Consolidation in home care
Rather than foster competition, the competitive bidding process has led to a consolidation in the home care field. Small community-based non-profits have been squeezed out in favour of a handful of large for-profit organizations. Six corporations held 76 per cent of the contracts by last fall, compared with eight corporations
holding 66 per cent in 1995. In 1995 there were 24 small community-based providers in Ontario; today there are only three.
Competitive bidding bureaucracy costly
The Ontario Health Coalition estimates that $66 million is spent annually on the competitive bidding process - money that doesn't provide a single nurse to a single community. Despite this high cost, there has never been a clearly demonstrated benefit to holding these competitions. In fact, the cost of home care has been
escalating to the point where one CCAC complained that they were forced to sign an agreement that increased the cost of each nursing visit by 48 per cent over the term of its three year contract with the service provider.
As a result, some CCACs have kept their direct care staff. In Renfrew, for example, it would have cost the CCAC $1 million more per year to contract out therapy services.
While the competitive bidding process has driven down wages and driven out skilled workers, it hasn't resulted in savings to the public. In Ottawa, the cost of contracting out therapy services rose by 35 per cent between April 2001 and March 2004. However, wage increases for unionized workers only amounted to 5.6 per cent in the
same period.
The process has created an unstable labour environment with major disruptions to the continuity of care. Paid on a per visit basis, home care workers are encouraged to get in and out as quickly as possible.
Major gap in accountability
Ontario spends $1.3 billion on home care, mostly outside of public scrutiny. The ministry's review of the Ottawa CCAC in 2004 revealed substantial examples of waste, attempts to hide cost overruns, and many questionable management practices - reasons why Ontarians need public scrutiny of these tax-funded organizations. The
Provincial Auditor noted last year that the ministry had yet to develop the "necessary processes for assessing whether the quality-of-service requirements specified in the requests for proposals were being met." Two of three CCACs he visited did not even track complaints.
Caplan's narrow mandate
With no mandate to look beyond the competitive bidding system, the Caplan Review could only tinker with the system, not replace it. Some of her recommendations are welcome, such as the move to longer contracts, greater access for public scrutiny, scoring for more generous human resources packages, an action line for abuse, and
the phasing out of elect-to-work employment. However, none of these measures will stem the tide of workers leaving the sector.
OPSEU believes that continuity of care is linked to the continuity of front-line staff, and while Caplan's recommendations are helpful, they are not the solution Ontario's home care patients are seeking. While Caplan sees a conflict of interest with CCACs directly providing care, she sees no conflict when companies performing
public duties also offer the same services privately. While rules exist around companies poaching their CCAC clients, it is something that is extremely hard to prove.
The CCACs that still provide a level of direct care do so because there was no alternative, or that alternative was prohibitively expensive. The mix of direct and contracted service delivery is no different than Ontario's hospitals. Caplan's insistence that this divestment continue will add to the already high cost of the
competitive bidding system.
Her recommendation to create a "Centre for Research and Quality in Home Care" will create yet another level of bureaucracy. Front line workers already know what quality home care is -- they struggle with a system that makes it increasingly harder to deliver.
- OPSEU May 30, 2005
