OCHU April 2003 Convention – Kenora
Beginning with its election in 1995, the current Ontario government instituted a policy of cutbacks to chronic care hospitals. The government decided that many patients in chronic care facilities should make do with significantly less support and care. Thousands of beds were shut and thousands more were scheduled to be shut. Patients previously taken care of in complex continuing care facilities would be moved to long-term care facilities (nursing homes and homes for the aged) – facilities with much less funding.
For complex continuing care hospital workers this policy raised the threat of layoffs and an attack wages, benefits, and collective agreements. OCHU, CUPE and concerned community members began to campaign against this policy.
The government has been forced to partially change directions from its full-out policy of cuts. The cuts were simply too dramatic for the government to sustain. So four chronic care hospitals scheduled to close down will now stay open. But serious consequences remain for other facilities: St. Joseph’s Health Centre in Guelph, Perley and Rideau Veteran’s Health Care Centre in Ottawa, and Malden Park Continuing Care Centre at Windsor Regional Hospital. The Brockville St. Vincent de Paul complex continuing care hospital remains woefully under funded.
OCHU/CUPE surveyed workers at these four sites and found that workers are faced with serious problems with unpaid work, workload, and patient care, as reported in previous conferences. Other problems also remain.
The Perley and Rideau Veterans Health Centre – Ottawa
The Perley and Rideau Veteran’s Health Care centre was until recently a chronic care hospital. The government has turned the facility into a long-term care (LTC) facility. LTC facilities (nursing homes and homes for the aged) typically operate with about half of the funding as chronic care hospitals. (About $100 per resident per day compared to about $275 per patient per day.)
As we feared, Local 870 now faces a major attack by the Perley on its wages and its collective agreement. The Perley refused to participate in the latest round of central bargaining. It has proposed a wage freeze and dozens of changes that would weaken the collective agreement. Nevertheless, the Perley has announced that they are increasing wages for bosses! The Local is fighting for the same collective agreement and the same wage increases as hospital locals. Interest arbitration dates are scheduled for later this year with OCHU and central CUPE hospital staff working with the local.
All hospital locals have an interest in ensuring this battle is won – governments must know that they will not be able to implement their funding cuts by making lowest paid workers in the health care work for even less!
St. Joseph’s Health Centre – Guelph
St. Joseph’s lost all of its acute beds and there was concern that its 90 complex continuing care beds would be reduced to only 30. With most of its beds long term care, the hospital also pulled out of central bargaining.
In this case, after pressure from the Local 1065 and OCHU, the Health Centre now has 60 complex continuing care beds and hopes for a significant increase in the number of rehabilitation beds. The Health Centre has also agreed to the terms of the central hospital collective agreement, including the wage increases. All RPNs that were laid off have now been recalled.
Nevertheless workload has increased in long term care. The new facility also has created problems: more single and double rooms create more work, and with the new public address system, it is almost impossible for workers to contact another worker when an incident occurs in one of the rooms.
St Vincent de Paul – Brockville
The future of St. Vincents continues to remain in doubt. The complex continuing care hospital hopes for new funding for a new building, but continues to suffer from under funding and operates with a large deficit.
The hospital has begun to turn to for-profit corporations. Sodexho has taken over the management of housekeeping, the kitchen, and maintenance. The staff in those departments are still employees of the hospital, but housekeeping staff has been reduced over the weekends. This despite the fact that the hospital has recently come through a significant problem with infection control!
Windsor Regional Hospital – Malden Park Continuing Care Centre Malden Park complex continuing care beds are currently being converted to long term care beds. Nevertheless, following the campaign by Local 1132 and OCHU, twenty-five more complex continuing care beds were awarded to the hospital and another 25 are expected. The Local also negotiated a new collective agreement with significant improvements for all workers, including Malden Park employees.
Overwork, however, is a major problem at Malden Park as well as recruitment of RPNs. The hospital has made clear that it is interested in public-private partnerships and there is concern that the hospital will allow a for-profit corporation to operate Malden Park.
Long Term Care Beds
Long term care beds (i.e. nursing home beds) have long been in hospitals, especially rural and northern hospitals. But with the conversion of complex continuing care beds into long term care beds, they have become a bigger factor in hospitals (and former hospitals).
There have been a number of unfortunate developments in the long term care (LTC) sector. The minimum 2 ¼ hours of nursing care per resident per day was eliminated while resident needs increased. This problem is further compounded by the government’s move to close complex continuing care beds and turn them into long term care beds.
A 2001 study by PriceWaterhouseCoopers indicates that with 2.04 hours per day of care the “data clearly indicates that Ontario LTC provides the fewest number of nursing hours per resident per day compared to other settings.” Saskatchewan has an average 3.04 hours per day.
About ½ of the operators in this sector are for-profit. The current Ontario government is awarding more beds to for-profit operators.
The result has been a powerful lobby for deregulated patient standards. With this we have seen the elimination of the 2 ¼ minimum number of hours of nursing care per resident and an increase in the percentage of beds allowed for those who can afford to pay extra.
Overall Funding and Staffing of Long Term Care Facilities
Since the 1995 provincial budget estimates, provincial funding for Long Term Care facilities increased 64% to $1.8 billion in the 2002 budget estimates. With the growth in the number of LTC beds and the increasing amount of care required by LTC residents, this funding should continue to increase.
Statistics Canada reports that staffing of nursing and residential care facilities by hourly rated employees has also increased but not nearly as rapidly as funding, increasing from 67,000 in 1995 to 76,000 in 2002, or 13%.
With the increasing acuity of residents in long term care facilities, funding has increased. In 2002, the nursing and personal care funding per resident per day increased in April and August, increasing from $52.38 to $59.81, a $7.43 per day increase, or 14%.
But again we see evidence that much of this funding is not going to hourly paid workers.
The government claimed that this funding increase will translate into roughly 2, 400 hirings for nurses and personal care workers. Residents were supposed to get more care. Unfortunately, the LTC facilities have put the money into all sorts of things, but not usually staffing. Both the funding and the improved care have disappeared into a black hole of unaccountability. Instead of improved staffing, nursing homes have reduced municipal subsidies, bought incontinence and nursing supplies or reduced their deficits. There have even been lay-offs in some homes.
User Fee Co-Payments
On June 28, 2002, the Ontario Government increased the amount charged to nursing home and complex continuing care residents accommodation user fee. Usually the increases only reflect changes in the Consumer Price Index. So previous annual increases were only about $1/day. But this year’s increase was much higher – $7.02/day or about $210 a month – a 15% rate increase.
Following broad based outrage over this increase from elders, the Ontario Health Coalition, and trade unions, the government backed down somewhat. On July 31st, the Ministry of Health and Long-Term Care agreed to phase in the increase over a three-year period. The user fee will be increased by $3.02/day this year, followed by an additional increase of $2/day in each of the following two years. The maximum user fee for basic accommodation, effective September 1, 2002, will now be $47.53 in both nursing home and complex continuing care sectors.
Changing Nature of Complex Continuing Care Threatens Funding
Changes in the nature of complex continuing care have resulted in concern among hospitals about a loss of revenue from user fees charges. Specifically, residents can only be asked to pay a co-payment if they are permanent residents of the hospital. However, many complex programs now assist patients to move to other care settings. As a result, complex continuing care beds utilized by non-permanent residents may result in a $12,000 to $15,000 loss in revenue per bed per year. This loss of revenue should be compensated, but the extension of user fees to new categories of patients would erode public medicare and place an unfair burden on working people.