The way home care is run in Ontario could be in for a shakeup after the province's auditor general delivers a report into the Community Care Access Centres (CCACs) on Wednesday.
CCACs are the central gateways for accessing publicly-funded home care in Ontario. If you want a personal support worker to help Grandma get dressed, or a nurse to check on Grandpa at home after his surgery, your local CCAC is your one-stop shop.
Their services cost taxpayers $2.38 billion in 2014/15. CCACs spend the vast majority of this public money contracting private firms that in turn provide personal support workers and nurses.
Is it money well-spent?
That's the question Auditor-General Bonnie Lysyk has been examining for this past year. She will table a special report into the CCACs on Wednesday.
Ontario's auditor generally does no more than a couple special reports each year, and they almost always provide big news: probes into the gas plant cancellations, PanAm Games security, eHealth and Ornge, to name a few.
Will the auditor's report into CCACs be such a bombshell?
The auditor's report has already gone to the government and I've received information that the report will be critical, but not necessarily scathing. Still, you can expect that Health Minister Eric Hoskins will use the auditor's findings as ammunition for reforming the way home-care is delivered in Ontario.
The Community Care Access Centres model hasn't changed much in the nearly 20 years since it was created. Since then, the amount of home care provided annually has exploded.
And it only stands to grow even faster than the rest of the health care system, as the government tries to keep a lid on the expensive stuff (acute-care hospital beds and nursing homes) by providing care to people at home as long as possible.
In a system that served some 713,000 people last year, there can't help but be efficiencies. Below are some of the areas the auditor has examined.
Effectiveness of care
This is really the bottom line: are people getting quality home-care, delivered in an efficient way? The auditor will examine whether CCAC administrative costs are too high relative to the money spent on direct care.
Opposition MPPs have complained about the salaries of the chief executives of the province's 14 regional CCACs. They each earn (on average) more than Premier Kathleen Wynne's salary of $208,974.
The auditor will have something to say about that, and perhaps on the growth in six-figure compensation in this sector. (I found 438 people employed by CCACs on the latest Sunshine List of those earning $100,000 or more. None of them are personal support workers, in case you were wondering.)
Although CCACs are responsible for providing home-care, they actually employ very few home-care workers. Mostly, they contract large private firms (such as Care Partners or Bayshore Health Care) who employ PSWs and nurses.
A typical PSW earns $14.50 an hour. The system spends a lot more than that to provide a typical hour of home care. The auditor will be looking at exactly how much more, where the money goes, and whether taxpayers are getting the best value by contracting the private sector to provide public health care.
In an interview, NDP health critic France Gélinas said the auditor confided that she found it difficult to get some of this information. "It will be interesting to see how far she was able to follow the money and where she was blocked and not given access," said Gélinas.
Structure of CCACs
It's arguably one of the most important issues in healthcare administration, even if it's not all that thrilling to the average person. Is a structure that was put in place in 1996 really the best way to meet the need for home care in 2015 and beyond?
Home care: by the numbers
14: regional Community Care Access Centres in Ontario
713,000: people who used CCAC services
$2.38 billion: annual government funding to CCACs
28 million: hours personal support workers spent in patients' homes
6.8 million: home and community nursing visits
428: CCAC staff on the $100,000+ "Sunshine List"
(Source: Ontario Association of Community Care Access Centres. Figures are from 2014/15)