How can home-care users hold personal-support workers to account?

Problematic home-care experiences are common in Ontario — but clients say they have no effective complaints mechanism to turn to
By Mary Baxter - Published on August 7, 2018
Nurse guides an elderly man using a walker.
According to the non-profit Advocacy Centre for the Elderly, problematic home-care experiences are common in Ontario. (iStock.com/shapecharge)

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LONDON — Shirley Parent, 80, has multiple sclerosis and uses a wheelchair. She lives on her own in London and relies on public home-care services: four times a day, personal-support workers get her up or into bed and change her briefs — activities that require the use of an overhead sling lift. ParaMed, one of the three private agencies that provide her care, helps her in the afternoons and evenings.

Last Christmas, Parent says, one of the workers (ParaMed requires that two be present to operate the lift) arrived half an hour late. “They had problems putting on the sling, and I thought I was going to fall off the chair,” she says. “It was as if they had never put on a sling before.”

Just one worker showed up to assist when Parent returned home later that evening from a holiday dinner at her daughter’s home. Parent and the worker called ParaMed for help. The agency sent a male worker, although Parent had previously requested that it send only female assistants (home-care providers are required by law to be “sensitive” to such requests). She says that the man handled her roughly and that the workers failed to discard her soiled briefs or clean her wash bowl.

Parent says she has complained to her Local Health Integration Network, which administers home- and community-care services, four times this year — once, about the Christmas incident, at a face-to-face meeting with her caseworker in January, and three times, about other incidents, over the phone in March. Each time, she says, “some changes were made, but they slipped back.” Parent has also complained to a local MPP, whose assistant merely referred her back to the South West LHIN.

According to the Toronto-based non-profit Advocacy Centre for the Elderly, problematic home-care experiences like those Parent describes are common. “There’s a steady stream of calls to our agencies about home-care issues, particularly about quality of care,” says executive director Graham Webb. Common problems include workers not turning up on time (or at all) and workers not doing their assigned tasks (or doing them badly).

“We do need more oversight of the delivery of home care in Ontario,” Webb says.

For now, the 730,000 Ontarians who use home-care services have no effective quality-of-care complaints process to turn to. Clients can lodge complaints about workers and service providers with one of the province’s 14 LHINs — but if they’re not happy with how the network handles their concern, they have no legal recourse.

Provincial law requires LHINs to establish a complaints process for clients and their caregivers, and service-provider contracts include performance-standard provisions. However, “monitoring and evaluating employee performance is the role/responsibility of the contracted service provider,” writes Dan Brennan, a spokesperson for the South West LHIN, in an email. When a client makes a complaint, the LHIN works with the service provider and the client to try to resolve the issue.

Parent has documented 25 incidents — which have included workers screaming at her and not showing up to appointments on time — since Christmas. She says her problems have all involved personal-support workers from ParaMed and its subcontractor, Aquarius Home Healthcare Inc. (LHINs match home-care clients with agencies, so Parent does not have the ability to choose which agency delivers her care.)

J.P. Lovecky, ParaMed’s southwest district director, writes in an email to TVO.org that the company has reached out to Parent “to ensure her concerns and care needs are fully met. We have acknowledged, and apologized and pledge to do better for her and all our clients.”

Parent wants the health ministry to treat home-care complaints the same way it treats complaints involving long-term care facilities: by conducting an investigation and publicly posting its findings.

The Advocacy Centre for the Elderly, meanwhile, wants the province to allow home-care clients who are unhappy with the way LHINs have handled their quality-of-care complaints to appeal to the Health Services Appeal and Review Board. Clients can already appeal LHIN decisions about the amount of care they’ve been allotted, for example. Webb says the challenge is that the “capacity of HSARB would be overwhelmed” by such a change. “I don’t know what the mechanism would be that would limit those appeals where appropriate,” he adds.

The previous Liberal government took steps to improve oversight and transparency when it comes to quality-of-care issues. In 2015, for instance, it appointed the province’s first patient ombudsman, whose job is to investigate and resolve quality-of-care issues. (Webb notes, however, that while ombudsmen can make recommendations, they don’t have the authority to overturn quality-of-care decisions made by an LHIN.) And in February, the province set up a personal-support-worker registry, which lists workers who have completed a ministry-approved college program. Employers and the public will be able to use the registry “to verify a PSW’s credentials, conduct, and competence,” according to its website. Currently, five agencies are registered. Workers register themselves.

Via a form on the registry’s website, clients can submit complaints about the care they’ve received. But the registry won’t have the power to investigate such complaints. Instead, it will refer them to the employer, an LHIN, or the Ontario Human Rights Tribunal, as appropriate. “Based on the outcome of the investigation by the employer, the registry will take appropriate action, which may include removal from the registry,” writes David Jensen, a health-ministry spokesperson, in an email. It is unclear whether a worker who’s been removed will be able to re-register in the future.

The Advocacy Centre for the Elderly argues that the province should create a regulatory college, similar to those that oversee nurses and doctors. A college would be able to legally enforce professional standards and conduct its own investigations, Webb explains.

The province says it’s not ready to comment on the advocacy centre’s proposals. “Ontario’s new government will be determining how to proceed now that it has been sworn in,” Jensen writes.

So for now, all Parent can do is complain to her LHIN — and she still can’t challenge how the network handles her concerns. “To be a disabled person, at any age, can be very stressful,” she says, but especially “if you do not know what is happening each day with the people or agencies you rely on to care for you.”

This is one in a series of stories about issues affecting southwestern Ontario. It's brought to you with the assistance of faculty and students from Western University’s Faculty of Information and Media Studies.

Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.

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