Auditor wants thorough review of home care services

Ontario's auditor general has questions about why nearly 40 per cent of home care funds aren't for "face-to-face" care.

Thestar.com
Sept. 23, 2015
By Donovan Vincent

Nearly 40 per cent of the $1.5 billion the province spends on centres that provide home and community based health care doesn’t go toward “face-to-face” treatment of patients.

That’s among the key findings in a 65-page report from Ontario’s auditor general, who is calling for a thorough review of how community-care access centres deliver services to patients.

In her new report on community care access centres (CCACs) - not-for-profit provincial government organizations that help people access home and community-based health care outside hospital settings -- Ontario Auditor General Bonnie Lysyk details a maze-like system rife with inconsistencies in care and service delivery.

“The current home and community care service delivery model contributes to different experiences for patients, depending on where patients reside,’’ the auditor noted.

Community care access centres provide services such as nursing, personal support and physiotherapy for people of all ages with needs from short-term acute, to long-term chronic.

There are 14 centres in the province, with about 6,630 full-time employees.

Over 700,000 people are served by the centres, which receive $2.4 billion in funding from the province, and have 264 contracts with 160 third-party providers, such as the Victorian Order of Nurses.

Lysyk points out that 61 per cent of the centre’s expenditures go to “actual face-to-face treatment of patients.”

Determining what the proper proportion of funding for face-to-face patient care should be can be accomplished only “if we know how patient care co-ordination and administration activities in the current CCAC service delivery model add value to providing effective patient care,” the auditor said.

Hence her call for a “hard look” at how the centres and third-party service providers deliver health care and related support services.

Pointing out that her organization welcomes the auditor’s report, Catherine Brown, CEO of the Ontario Association of Community Care Access Centres said Wednesday that CCACs provide care in a broad sense, not just face-to-face treatment.

“The work to assess, consult with other professionals and pull together the right care is an essential, direct component of patient care,” she said.

But critics pounced on the auditor’s finding about the amount of expenditures going to face-to-face care.

“It’s quite concerning only 61 per cent of dollars are reaching face-to-face care,” MPP Jeff Yurek (Elgin-Middlesex-London), the Progressive Conservative health critic, said in an interview.

“You can see that in the lack of availability of services throughout the province and people being cut and discharged from CCAC services,” he added. He called for the province to act quickly to ensure that more dollars go to direct care.
Saying the report shows the home-care system is “broken” NDP health critic France Gélinas told the Ontario legislature Wednesday that the auditor makes it clear in her report that of the dollars reaching the patient side, no analysis was ever done to see if the money was spent with results.

“The auditor general made it clear that there are no standards that have been applied to this money to make sure we guarantee access, that we guarantee quality of care or care levels. None of the work that is the responsibility of the government has been done,” Gélinas added.

“The evidence provided by today’s special audit should highlight not only the well-known problems in the CCACs but also the problems inherent in a contracting and sub-contracting system, and the profit-taking and lack of public accountability of private home care corporations,” Natalie Mehra, executive director of the Ontario Health Coalition said in a statement.

Ontario’s minister of Health and Long-Term Care Eric Hoskins said in a statement Wednesday that the provincial government “accepts and endorses” all of the recommendations in the auditor’s report.

Noting the province is increasing its investment in home and community care by $750 million over three years, Hoskins said that through a new working group the province is looking at provider contracts and fees to ensure consistency, access and quality of services across the province.

Among her 16 recommendations the auditor is calling for:

The Ministry of Health and Long-Term Care in conjunction with Local Health Integration Networks (LHINs) to finalize annual funding to CCACs before the fiscal year begins, or as early in the fiscal year as possible so the centres can properly plan to meet patient-care needs.

A common compensation framework for CEO’s of the centres, to ensure their pay is “defendable” and consistent.

An analysis of the relationship between specific patient-care activities and patient outcomes.

Four key findings in Ontario Auditor General Bonnie Lysyk’s report on Community Care Access Centres:

There are no province-wide standard clinical-care protocols for service providers across the system to use for patients with the same medical conditions.

Complex-needs patients across Ontario who are discharged from hospital, and who are eligible to receive transition care at home, don’t consistently receive this care within the required 24 hours, the auditor noted.

The 14 community care access centres paid their CEOs an average of $250,000 each in 2013, up 27 per cent compared to the average in 2009.

Community care access centres pay inconsistent rates to contracted service providers for the same care services, so for example one provider charged $48.98 per hour for personal support services in one geographic area, and $29.50 in another.