Home care in the crosshairs

Now that we’ve learned the gruesome facts of life in long term care, many of us seniors are more determined than ever to keep out of those hellholes, and age at home with the support of home care. But can we?

Ontario home care is a mare’s nest of stresses and strains. Unlike hospital care, it isn’t insured by the Canada Health Act. It’s a provincial responsibility, and the provinces invest some of their transfer money in it. How much? What’s covered? Good luck finding out. For years it has been administered in Ontario by the CCACs, now the LHINs, and soon it will be the Ontario Health Teams. What coverage you qualify for depends on the funding choices made by your local health agency. What care you get, or even whether you qualify for care at all, depends entirely on where you live in the province. Meanwhile, the demand for home care keeps growing. It’s not just because the population is aging. For years, Ontario has been aggressively shifting health care out of the hospitals and into people’s homes. Advances in technology have made it possible to deliver many treatments at home, such as chemotherapy, intravenous therapy, and mechanical ventilation. But funding and services have not increased to keep pace with these growing needs. The burden often falls on unpaid family caregivers, or, for those who can afford it, private care. If you’re on your own on a low income, you may be out of luck.

And now, while everyone has been preoccupied with the pandemic, along comes Bill 175, Connecting people to home and community care. According to analyses by the Ontario Health Coalition and other advocacy groups, here’s what it does:

• Repeals the existing Home and Community Services Act and transfers most of it to regulation which can be changed by Cabinet members without ever going to a vote in the Legislature.
• Dismantles all public governance of home care and transfers it to provider companies, including for-profit companies, which are not accountable to the public. These corporations can contract and subcontract home and community care amongst themselves with no oversight.
• Makes no provision to ensure or improve access to care or quality of care.
• Enables private home care to go into public hospitals, and even enables private for-profit hospitals to expand into the newly created tier of unlicensed congregate care.

Introduced without input from advocacy groups, client representatives, or workers’ and health professionals’ representatives, Bill 175 was rushed through first and second reading in the Legislature in early June. The NDP health critic brought forward more than 20 amendments to Bill 175, all of which were voted down. Advocacy groups have staged protests, but the legislation is headed for third reading and royal assent.

It’s a big win for private interests, a big loss for public home care in Ontario, and a big worry for seniors who were hoping to age at home.