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...

"We’re under constant pressure to speed up — even though we’re on a salary. But sometimes a 15-minute visit turns into a three-hour visit because your client is sick. Can you imagine what it’s like for those on a piecework system — paid per visit with no travel time. If I see something’s wrong, I need to know I can take the time to do a good job and address all the problems without feeling like I’m losing wages. Piecework definitely affects your judgement."

Ross Sutherland, Nurse, Victoria Order of Nurses (VON), Kingston ON, CUPE 3932

Out of pocket expenses on rise

Under the current patchwork system, home care often means additional out-of-pocket costs that would have been covered in hospital, including drugs and other medical supplies. The earlier a patient is released, the greater their personal expenses. User fees are on the rise, with an estimated 42 per cent of home care recipients paying for services not covered under the public system.

Statistics Canada reports that between 1992 and 1997 the average household expenditure for health care supplies increased by 144 per cent, from $33 to $80. Household spending on medicine and pharmaceutical products increased 51 per cent, from $222 in 1992 to $336 in 1997. The overall increase in household expenditures for health care was 30.5 per cent. During that same period provincial and local government expenditures on health care only increased by 7.4 per cent.

In Saskatchewan, user fees are incorporated into the home care equation. Everyone pays for the first 10 hours or 10 meals (10 units) of "non-medical" service at $5.55 an hour. After this, payments are to a maximum of $320 a month, based on income. Here, out-of-pocket expenses totalled $94 for each acute care case sent to home care.

Private expenditures on health care in Ontario have increased from nearly $6.5 billion in 1990 to $10.5 billion in 1998, the greatest percentage increase of any Canadian province or territory. In another new trend, people are taking out private insurance in case they live — not die. In Quebec, the number of people who have taken out private insurance to cover home care and other costs increased 15 per cent between 1995 and 1998.