She begged for help as husband struggled: Why home care is failing thousands while companies profit

Nearly one million Canadians rely on some sort of home care support, but a Marketplace investigation has found a shroud of secrecy around for-profit companies’ use of public funds. Critics say the broken system is providing substandard care – and sometimes no care at all – for those most vulnerable.

Marketplace investigation finds neglect of care, missed visits with little accountability

Willie Foreman says after her husband, Robert Foreman, had a stroke, the home care giant Paramed provided service that was ‘so sporadic and frustrating’ she was forced to put him in a nursing home. (Submitted by Willie Foreman)

Willie Foreman promised her husband, Robert, that she would look after him at home after he suffered a debilitating stroke and became paralyzed, leaving him unable to dress, toilet or feed himself.

But that became impossible, she said, after the publicly funded home care company that was supposed to help her husband of 50 years — Paramed, owned by long-term care conglomerate Extendicare — was so unreliable she was forced to put him in hospital, where he waited months for a bed in a nursing home.

"I begged [Paramed] to send somebody," said Foreman, in London, Ont. "It was terribly frustrating."

Nearly one million Canadians rely on some sort of home care support, but a Marketplace investigation has found a shroud of secrecy around companies' use of public funds.

Interviews with industry insiders and documents obtained by Marketplace reveal a system with so few checks and balances that it's leading to missed home visits, downloading of care and front-line workers so poorly paid they are leaving the sector in droves.

"We don't publicly report or collect home care data in the way we do for long-term care," said Tamara Daly, a political economist and health services researcher at the York University in Toronto. 

"That is a massive problem." 

Robert Foreman says it was ‘much better living at home’ after a severe stroke, but the home care company contracted to help – Paramed – didn’t deliver, so he has to live in a nursing home. (Submitted by Willie Foreman)

Across the country, home care is publicly funded, but how it's delivered varies widely. B.C., Saskatchewan and the territories deliver public home care themselves. All other provinces also contract private companies.

Ontario issues thousands of contracts to home care providers to deliver services to about 700,000 people — some companies are not-for-profit, but the majority and biggest players are largely for-profit companies.

Those contracts fall under a provision of the Freedom of Information and Protection of Privacy Act that shields them from public scrutiny.

"These companies have no pressure to be transparent, so we really can't say that the money is going for good care," said Daly. "We publicly fund this. We're entitled to know this information."

Missed visits

After Robert Foreman, 73, was sent home from hospital in 2015, Paramed was contracted to send two personal support workers (PSWs) to provide care, twice a day for 45 minutes. 

But his wife said that at least twice a week, that didn't happen — only one PSW showed up or no one came at all.

"I was beyond being able to know what to do anymore," she said.

So how often do home care companies miss appointments the government pays them to deliver?

WATCH: Home care crisis costing Canadians:

Why home care is failing thousands of Canadians

1 year ago
Duration 2:14
Experts and documents obtained by Marketplace reveal a system with few checks and balances, a crisis in care.

A privacy officer for Ontario's Home and Community Support Services said that information wasn't easily available — 14 health regions would take months and likely charge fees for collecting that data and even then, in order to release the names of the private home care companies involved, she would have to get permission from those companies.

An auditor general's report released in December 2021 also said the Ontario government had "little information" on the frequency of missed home care visits, as private companies aren't required to report how often that happens. 

"It's wrong," said Natalie Mehra, executive director of the Ontario Health Coalition and a longtime advocate for public health care. "There is no public interest justification in keeping secret [what's in] commercial contracts with public money."

Personal support workers double-booked

Marketplace spoke to a number of PSWs who said they know why some clients' visits are missed — the companies they work for schedule appointments back-to-back with no travel time between and sometimes double-book appointments with clients or schedule overlapping appointments.

"Probably once a week I'll look at my schedule and it'll be overlapped or double-booked," said a PSW who has worked for Paramed for more than five years. CBC is not revealing his name to protect his employment. 

A personal support worker makes calls to clients before he starts his shift. He says his employer, Paramed, sometimes schedules him to see two clients at the same time. (Norm Arnold/CBC)

"They can make double what they make in an hour sometimes … and they're shorting the client." 

'They still get their money'

Allegations of public dollars sometimes going to home care companies for services that aren't delivered is a well-known secret, according to Mehra.

"Home care companies get contracts for … visits that they do not fulfil, yet they still get their money," she said. "Nobody is held accountable for that in any way."

Marketplace put the allegations to Paramed and requested an interview, but the company declined to comment, saying the industry's association, Home Care Ontario, would address our findings. 

Home Care Ontario declined an interview request and issued a statement from CEO Sue VanderBent that didn't address concerns about billing for missed visits.

VanderBent did say the industry was "in crisis," pointing out that health-care professionals are paid more to work in other parts of the system.

"As a result, staff have left home care by the thousands during the pandemic," she wrote, and called on the provincial government for more funding to pay workers better wages.

'I was in sheer and utter shock'

Maxine McLean said she didn't get anywhere near the home care promised for her ailing husband.

Mike McLean, 76, was losing a battle with blood cancer and was sent home from an Ottawa hospital in February 2020 for palliative home care to be provided by Bayshore Home Health — another giant home care provider. 

Home care giant Bayshore was contracted to provide palliative care for Mike McLean, who was suffering from blood cancer. No one from Bayshore paid a visit in the eight days leading up to his death. (Submitted by Maxine McLean)

But McLean said in the six weeks leading up to her husband's death, much of the care that Bayshore promised was downloaded onto the family — and twice, nurses didn't come for more than a week, including in the eight days prior to her husband's death.

Perhaps most traumatizing, she said, was Bayshore's expectation that her daughter — a nurse — would have to personally administer medication to ease her father's transition to death.

"She's crying," said McLean. "She says, 'Mom, I just can't.' I was in sheer and utter shock."

WATCH | Family told to give loved one 'end-of-life medication':

Family left on its own to deliver palliative care

1 year ago
Duration 2:18
Mike McLean was supposed to receive palliative home care from Bayshore Home Health, but his wife Maxine McLean and son Trevor McLean said much of that care was downloaded onto the family. Home Care Ontario, responding on behalf of Bayshore, said the industry is in a staffing crisis but didn't address the McLeans' concerns.

Marketplace repeatedly requested an interview with Bayshore but never heard back. Finally, the company's lawyer said Home Care Ontario would speak for them, too.

The statement from Home Care Ontario did not address the McLeans' concerns. 

Mehra, the health-care advocate, said she's not surprised by the McLeans' devastating experience.

"People [leaving hospital] are promised the sun and the moon," she said. "And they get home and no home care materializes. " 

PSWs barely paid more than minimum wage

Besides secret contracts between government and home care providers, Mehra blames the profit element involved in the industry.

"The for-profits have to make room for profit," she said, adding that they do that by generally paying their front-line workers less money than not-for-profit counterparts. 

Ontario PSWs working in home care start at $16.50 an hour. In Saskatchewan, where the government delivers home care, the collective agreement with the union representing PSWs shows they make about $7 more an hour.

Natalie Mehra, executive director of the Ontario Health Coalition and a longtime advocate for public health care, says for-profit home care companies generally pay their employees less than not-for-profit companies. (Joe Fiorino/CBC)

On top of low wages, PSWs told Marketplace that companies only pay them for the time spent with clients. There is no compensation for their travel time or the time spent each day contacting clients to let them know they're on their way — which can add several hours a day of unpaid work.

"These home care companies are claiming the problems are due to the pandemic — 'It's not our fault, people didn't call into work,'" said health researcher Daly. 

"What the corporations are doing is placing the burden of care on these poorly paid workers." 

Ontario Premier Doug Ford declined an interview request, as did Health Minister Christine Elliott. 

At an unrelated news conference two weeks ago, Elliott told a Marketplace producer that all players — for-profit home care companies and not-for-profit — are "important." 

A statement from the Ontario Ministry of Health said it's investing more money in home care and is "committed to ensuring that Ontarians have access to the home care services they need." 

Meantime, Foreman said not a day goes by that she doesn't feel she failed her husband, for being unable to care for him at home.

"I feel pretty guilty," she said. "But I just can't do it anymore."