Going once, going twice... Health care giants bid for home care

 Cashing in on need

 Ontario: Primed for costly privatization

 The cost of competition

 Staffing problems

 Out of pocket expenses on rise

 Funding and access cutbacks

 Home care is about women

 The need for federal action

 For-profit home care provision: expanding the market

 Olsten’s shoddy track record

 What is your province doing?

 Corporate classrooms costly...

"For a 75-year-old community organization to be wiped out at the stroke of a pen is unbelievable. They never asked anyone — doctors, patients, case managers, caregivers. I worked for seven years as a VON visiting nurse doing palliative care. People trust you to see them right to the end. But that trust takes years to build. You can’t just walk in as someone’s dying. And you can’t put a price on that kind of care. The compromise they’ve made for money is sinful. Absolutely sinful."

Heather Stevanka,
former VON nurse, Windsor ON, CUPE 3741

The cost of competition

The Ontario government claims that rationing CCAC funds and forcing competitive bidding will deliver more efficient home care. Private home care, however, costs more. Higher administrative costs for billing, bidding processes, marketing and sales drive up private health care costs. US research shows that for-profit companies spend about 40 per cent more than government agencies and 25 per cent more than non-profit agencies to provide home care.

Ontario’s Auditor General says administering ‘competition’ drains funds, noting that the Requests for Proposals "require significant resources." At the Ottawa-Carleton CCAC, choosing private contractors has cost between $750,000 — $830,000 per year in extra administration costs. Also, the Ottawa CCAC bears the risk if the private company goes out of business, including an extra $4 million in sick leave, holidays and severance payments.

The whole system makes a mockery of public accountability. The Ontario government has delegated responsibility for home care to CCAC’s without providing adequate funding. The CCAC’s in turn have contracted out care to the lowest bidder without an adequate process to assure quality.

The provincial Auditor criticizes the current home care system for not giving assurances about quality of care. There is no formal process to record or resolve complaints. Individual CCACs are left to decide whether to include quality requirements in the bidding process, and how much weight to give them.

There are few systems in place to monitor private companies spending public funds. In the United States, the General Accounting Office and other state level agencies monitor the activities of private companies, increasing the likelihood of uncovering fraud. It is unlikely that any such misuse of funds would be detected in Canada. In fact, the Ontario Auditor General states the home care system "does not ensure that funds will be used efficiently." The problem is compounded by the lack of financial disclosure legislation in Canada, comparable to that required in the United States. Some CCACs do request information about a bidding company’s record in care delivery, labour relations and use of public funds, but others do not, highlighting the inconsistency across the system.