In February, as COVID-19 spread rapidly around the world, Simone Atungo watched and waited. Before the province declared a state of emergency in March, Atungo, the CEO of Vibrant Healthcare Alliance, in Toronto — a community health centre that also provides supportive-housing services — instituted precautions: workers were required to use personal protective equipment; staff, residents, and visitors were screened; and single points of entry were established at buildings. “We were on it,” she says. It’s thanks to that early effort, she believes, that no one associated with the centre got sick.
Now, the veteran health-care administrator sees a new challenge — one posed by Bill 175, the Connecting People to Home and Community Care Act. The legislation, which was introduced on February 25 and received Royal Assent on July 8, changes who is responsible for administering home and community care. In this case, there wasn’t time to prepare, she says, because, ahead of its introduction, there was little consultation with people who receive and deliver care — something groups representing those who receive services, such as Care Watch, have also noted.
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“How quickly this bill was rushed through is very concerning,” Atungo says. “I didn’t see any invitation to public consultation with health-care professionals or clients or advocates in the field.”
The legislation — part of the provincial government’s restructuring of health-care, which was announced in 2019 — transfers responsibility for the delivery of home- and community-care services to Ontario health teams from local health-integration networks. The teams are made up of health-care providers, such as hospitals, family doctors, nurse-practitioners, long-term-care facilities, and services that provide home care, community support, and mental-health care. The networks, rebranded as Home and Community Care Services, will remain responsible for coordinating home- and community-support services until the teams can take over. Services that will eventually be transferred to the teams include client intake; evaluating clients’ eligibility for services; planning, allocating, and arranging for the services clients receive; and managing their cases.
Several health-care advocacy groups, including the Ontario Nurses Association, have raised concerns about the act. In a June submission to the standing committee on the legislative-assembly consultations on the legislation, ARCH Disability Law Centre, in Toronto, said that, although private services are already used in the home- and community-care sector, the legislation opens the door to further privatization by allowing health teams to hand over the responsibility of developing care plans to private services. The care-coordination services currently supplied by the LHINs “are central to the delivery of services,” it writes. The decision to shift these “sizeable responsibilities to an unidentified and unaccountable health service provider raises red flags” because it “may sacrifice quality of services for fiscal efficiency.”
The centre is also concerned that the wording of the legislation doesn’t make clear the distinction between persons with disabilities and other types of home- and community-care clients: those who receive services are simply referred to as “patients.” “These communities of people are not interchangeable,” the submissions says, noting that “the word ‘patient’ reinforces the idea that persons with disabilities are not active consumers of services and supports that enable them to participate in society.”
A spokesperson for the Ministry of Health says via email that “the Ontario government legislation in no way enables the privatization of home care.” The ministry, they add, restricts the services that can be charged for under home and community care; existing contracts with providers won’t change immediately. And non-profit organizations will continue to deliver community supports: “As Ontario Health Teams begin delivering home care services over the coming years, new and innovative models will emerge.”
Amy Boudreau, a spokesperson for Care for Health and Community Services, a non-profit provider of home- and community-care services, and for the Ottawa Health Team, says the legislation will help integrate home and community health care into the larger health-care sector: “We’re very supportive of how the legislation has focused on integration and getting away from the transactional care approach that we have today and much more to a holistic approach to care.”
Boudreau adds, though, that the government should be doing more to establish pay equity for home- and community-care workers so that their earnings are on par with those of their colleagues in hospitals and long-term care. The legislation hasn’t made it clear whether pay equity is a priority, she says — and the fact that home- and community-care workers are still paid less than their colleagues in long-term care “makes it very challenging for us to recruit and retain people in a sector that we really believe is best suited to meet the needs and the choice of our community members.” (A Ministry of Health spokesperson previously told TVO.org that the provincial government introduced wage improvements for such workers well before the pandemic.)
Chris Stigas, who has relied on home-care workers to assist with routine activities since he was left paralyzed by a spinal-cord injury in 2014, says he’s disappointed that the new legislation does not address pay equity for home-care workers. He’s also concerned that long-term-care and home- and community-care settings will be governed by different laws — what applies in one sector should apply in the other, he says: the laws “should be put together.”
But, even though the two settings confront similar issues and share workers, he says, different standards apply: “If there’s an issue with long-term-care homes or retirement homes, there’s a ministry to be able to call for that. But, if there’s a problem with assisted living or supportive housing, there’s no ministry for that — even though we are also recognized as a high-risk population for COVID and other health challenges.”
Stigas says he has raised these issues with the Ontario Patient Ombudsman’s office and is awaiting a response from Cathy Fooks, who assumed the ombudsman role earlier this month. However, when he spoke to staff there, he says, “they told me flat out that their inquiry [into the COVID-19 outbreaks in long-term care], the scope of it, is not going to be looking into assisted living and supportive housing, but that she will make a note of it and bring it up.”
The government appears to treat long-term care and home and community care as “two separate ... silos and separate systems,” he says, adding, “How does that make sense to a group of people who are just as at risk in their congregate settings?” He believes that the COVID-19 outbreaks that occurred in long-term-care and retirement homes could just as easily have occurred in assisted living and supportive housing: “The setting, the labour, it’s all the same, and the culture’s the same, and the approach is the same.”
For Atungo, it’s gaps such as these that mean there should be a new consultation process “on what home and community care reform should look like” — and revised legislation. “The bill is supposed to modernize the delivery of home-care services,” she says. “But it looked like, in my view, anyway, it’s having the opposite effect.”
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.
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