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...

Manitoba’s public home care — a model for Canada

Twenty-five years ago, Manitoba introduced Canada’s first province-wide continuing care program. This public home care service is now lauded as a model for other provinces.

The program serves over 30,000 Manitobans a year with medical, rehabilitation and support services in their home. Elderly and physically disabled adults benefit the most. The per person cost of providing these services — which help people return home from hospital or avoid moving to a nursing home — is modest. The program as a whole accounts for about four per cent of Manitoba’s health care costs. All home care services are delivered in a public system without user fees.

An assessment process determines who is eligible, with an appeals process for those who feel that they have not been properly assessed. The program is part of a continuum of services that includes respite care, day programs and personal care homes.

In 1996, Manitoba flirted with the private delivery of home care. The relationship was short-lived. Massive negative public reaction, and a strike by the province’s home care workers, forced the government to scale back plans to privatize. Less than a year later, the government announced it would not renew its contract with the American home care contractor, Olsten, having concluded the public system provided better and cheaper care.

With Olsten out of the picture, Manitoba’s home care program remains in public hands, where it belongs.

The need for federal action

Home care across this country consists of a bewildering array of programs that leave many Canadians confused and unsure where to turn for help. There are no common regulations guiding the quality of care and little coordination of home and continuing community care. A 1998 Canada Health Monitor poll found 84 per cent of respondents favoured a national home care program.

A federal Home and Community Care Act would provide direction and guidelines for provinces to meet the growing home care needs of Canadians. The Act would have principles similar to those of the Canada Health Act and provide a framework for funding home care on a cost-shared basis with the provinces. Federal money would flow to the provinces whose programs met criteria established in the Act.

Guidelines for the proper training of home care workers and the regulation of home care delivery would be central to the Act. Over 80 per cent of all home care is provided by home support workers — the lowest paid, least trained and only unregulated component of the home care workforce.

There is tremendous disparity in home care standards across the country. There are no standard training requirements across provinces. British Columbia, Saskatchewan, Manitoba, Ontario and Quebec have requirements ranging from a 22-week community college program in BC to 2 years on-the-job training in Saskatchewan. The remaining five provinces have no mandatory training program. None of the provinces requires training for those who deliver care privately.

A national home care act would also ensure that home care is not abused as a cheap replacement when hospital or other institutional care would be more appropriate. The result of releasing patients prematurely is higher costs, as patients relapse and must be readmitted to hospital. A national home care program will provide blended care that provides care to people in their homes only when that is the best option for the patient.