Ontario must shape up home care system, auditor general says

Ontario has plenty of work to do to ensure money in its home care system is going to the right places, says the province's auditor general in a new report.

Out of hospital health care affected by differing patient experiences and inconsistent pay rates

Ontario Auditor General Bonnie Lysyk reveals discrepancies in pay and service for employees and patients in a new report on the home care system. (Nathan Denette/Canadian Press)

Ontario has plenty of work to do to ensure money in its home care system is going to the right places, says the province's auditor general in a new report.

The report, released Wednesday morning by Auditor General Bonnie Lysyk, highlights the rising costs and discrepancies in treatment with services provided by the province's Community Care Access Centres – which are the central gateways for accessing publicly-funded home care – and third parties.

The 14 CCACs co-ordinate home and community-based nursing care, therapy and supports to about 700,000 patients outside of hospitals, and in some cases provide direct care.

"The current home- and community-care service delivery model contributes to different experiences for patients, depending on where patients reside," Lysyk said.

"In the two decades since the inception of the CCACs, there has never been a thorough review to determine whether the current delivery model is providing consistent, equitable and cost-effective care," the auditor general added.

Some key issues highlighted by the report include a lack of clarity on healthcare costs. For example. CCACs claim 92 per cent of their expenditures go to direct patient care, but that figure drops to 72 per cent when only counting services with direct interaction with patients, the report said. When only including face-to-face treatments, that number drops down to 61 per cent.

"Assessing the proportion of funding that should go to face-to-face treatment of patients can only be done 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 news release said.

With figures in for March 31, 2014, health-care costs per client ranged from $2,892 to $3,775, varying on which CCAC is used to treat patients.

The report found inconsistent rates from different services provided for the same healthcare services.

The news release revealed an example in the report that saw one service charged $48.98 per hour in one area and $29.50 in another, although both fell under CCAC. There are 14,000 different contract rates for 94 service categories.

Similar discrepancies exist with registered nurses, the report stated. Those providing direct services to patients under CCAC were paid an hourly rate between $39.40 and $43.70, but the report found nine service providers seen during the audit were paid between $25 and $34 an hour.

The auditor general discovered CCAC nurses were paid $40.80 an hour compared to an average of $30 an hour for nurses employed by service provides.

"The difference in pay is due to nursing unions negotiating different pay rates with CCACs and service providers," the report said.

The auditor general also found patients with complex needs didn't receive transitional care at home within 24 hours, as required. In the year ending March 31, 2014, 47 per cent of patients in 14 CCACs weren't seen within a day after being released from hospital, the report stated.

It should also be noted CCAC chief executive officers saw their salaries skyrocket 27 per cent between 2009 and 2013, the report said.

CCAC expenses were also up 26 per cent between 2009-10 and 2013-14 to provide health-care patients with chronic and complex needs with more hours of care, the report found.

You can read the full report here.

Less than the hour before the auditor's report came out, the premier held a news conference about select grocery stores in the province being allowed to sell beer by Christmas.

Ontario PC leader Patrick Brown questioned the timing of the announcement.

"It's a bit insulting to have this announcement today when we knew the CCAC report was coming down and [there are] concerns over executive compensation, and [there are] real challenges we're facing with home care in Ontario," he said.

"I' think it's very strategic of the government to distract [us] with beer."


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