Pilot project to give cash to Ontario patients for ‘self-directed’ home care.

In a bid to respond to a blistering report on home care in Ontario, the provincial government is promising a series of minor fixes to the system, including a Canadian-first pilot project that would give patients or their caregivers money to spend on the home health services of their choosing.

Details were scant on the government’s plans for experimenting with “self-directed care,” an approach that Health Minister Eric Hoskins said is already working well for some parents of autistic children who have been given the flexibility to spend public funds on the programs they believe are best for their children.

Dr. Hoskins said that although it was too early to say where the pilot programs would be located, who would qualify or how much they would cost, he was excited about eventually offering more choice to patients as they heal or age at home.

“We will provide them with the funds to effectively purchase their own home care under terms where they will have even greater control,” he told reporters Wednesday at the Second Mile Club, a seniors’ day program in Toronto. “We’ll start, obviously, at a smaller scale to allow us the opportunity to make sure we get it right.”

The minister also announced some other changes to the home-care system, including $5-million for funding 80,000 more hours of at-home nursing care by raising the cap to 150 visits per month from the current limit of 120; developing a “statement of values,” for the system; and making it clear which services are available to patients in their homes, no matter where in the province they live.

He rehashed some old promises too, including the extension of 5-per-cent annual increases in funding for home and community care and the phasing in of a $4-an-hour raise for home-care personal support workers, which The Globe and Mail reported has been delayed this year because of problems with the rollout last year.

Experimenting with self-directed care was one of 16 recommendations for improving home care made in March by a group of experts led by Gail Donner, the former dean of the Faculty of Nursing at the University of Toronto.

“It’s a positive first step, a really good beginning,” Dr. Donner said Wednesday of the minister’s 10-point plan. “I’m glad he mentioned this is the first phase because we have still lots of work to do in the transformation.”

Dr. Donner’s report criticized Ontario’s publicly funded home care sector as disjointed, opaque and onerous to navigate, making it “a system that fails to meet the needs of clients and families.”

But the report also acknowledged the breadth and depth of the challenge faced by the 14 local Community Care Access Centres that co-ordinate home care in a province that is moving aggressively to keep patients out of expensive hospital and nursing home beds.

Although the Liberals have doubled funding for home and community care since taking office in 2003, the number of patients receiving services through the CCACs has also doubled in that time, with a sharp increase in the number of complex-needs, long-term patients seeking care, the report said.

Auditor-General Bonnie Lysyk is currently investigating the CCACs, but she told The Globe and Mail Wednesday that her findings will be released in the fall, not this spring as was widely expected. Her audit will be released in two parts – the first will respond directly to a request from opposition members of a legislative committee and the second will be part of her annual report in December.

Some groups, including the Registered Nurses’ Association of Ontario, have called for the CCACs to be scrapped altogether, but both Dr. Donner and Dr. Hoskins said Wednesday that basic fixes must precede larger reform.

“We believe we need to get … some consistency, transparency and accountability into the system,” Dr. Donner said. “Then, do we need to deal with the structure? Yes we do. Our view was that’s not where you start.”

The province-wide organizations that represents the CCACs welcomed the minister’s announcement, as did the health-care arm of the Service Employees International Union [SEIU], the labour group that advocated for the raise for personal support workers.

But Michael Hurley, the president of the Ontario Council of Hospital Unions, which is part of CUPE, slammed the plan as falling woefully short of the needs in the sector.

“We can’t pretend to people that it’s possible to downsize the acute-care sector and that they can rely on the community sector without a substantial investment and this doesn’t deliver that,” he said. “We haven’t been given a system, we’ve been given another announcement of an another experiment.”


KELLY GRANT – Health reporter

The Globe and Mail


Published Wednesday, May. 13 2015, 6:55 AM EDT

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