Mismanagement of Healthcare Funds: Support Workers Share Their Experience

Each year, the Ontario government spends over $2 billion dollars on home services, including nurses, social workers, personal service workers and therapists. But did you know that some of the workers providing that care end up with a net paycheck of $0 — or even pay to work — and have to turn away patients that they have the time to treat? It’s a reality for several caregivers in our province. 
During the campaign, several of these first-line support workers and their families have contacted the Green Party of Ontario, wanting to share their experiences working with Community Care Access Centers, or CCACs — centers that organize access to personal support — and raise awareness about problems in CCAC management.
Up until 1997, CCACs provided one-stop services — they’d assess a patient’s need, provide therapy and personal support, and continue to monitor and manage their progress. Therapies included nursing, speech therapy, occupational therapy, physiotherapy, social work, and nutritional counselling, all of which contribute to maximize recovery and retain independent living. Then, the Harris government required CCACs to contract out services to the private sector, which would then contract therapists and personal support workers. The CCAC role shifted to managing and assessing cases, and monitoring the private agencies’ performance.
In their new role, CCACs began to grow their management force, redeploying more and more government funding to build up layers of management, increase salaries, and run public relations campaigns. In addition, funding for front-line workers who actually provide support have been diverted to private agency overheads and profit, even as Ministry of Health and Long-Term Care funding for home care increases.
According to a report compiled by front-line workers and given to the GPO, as little as 51 percent of funds allocated to home care delivery in the Waterloo-Wellington CCAC actually reach front-line support workers, with a massive 41 to 49 percent being absorbed by private agencies. This systemic inefficiency hurts patients who desperately need home care services, and creates working situations that punish highly-trained healthcare professionals and prevent them from doing their jobs.
Bureaucracy Limits Access to Support
The level of bureaucracy surrounding care provided by CCACs means that many may not access the care they need. Therapists report that on occasion, CCACs have required care providers to ration their services to avoid going over anticipated budget shortfalls. Even those workers who were prepared to take on more clients were not accommodated due to budget constraints.
The level of service rationing is wrong. “Many front-line professionals are working at 15-20% capacity while the wait lists for these services grow locally into the thousands,” writes Janet Jones*, whose husband works as a speech language pathologist. And yet, “families of those kids who are waiting are suffering.”
At the other end of the spectrum, privatized health support combined with strained budgets causes another unintended consequence: treatment is determined by how much a patient is assigned by CCACs, and not necessarily what they actually need.
If allocation algorithms or formulas assign patients more care than they really need, the unnecessary service may be provided anyway to maximize profits, even though that money could have helped someone else. The system has no incentives to deliver all the care that clients do need and none that they don’t need.
Arbitrary Decisions Determine Access to Care
In the past, the front-line therapists assessed and delivered healthcare to those in need, but now they must jump through hoops to serve many patients. CCACs slow client assessment, requiring preliminary phone interviews that can delay direct treatment for a week or more.
Then, after in-person assessments have been completed, it’s left to computer algorithms to determine the level and duration of support that clients can receive. Therapists, who are actually on-site with clients, report that attempting to overrule algorithm-based service assignments is often futile.
These circumstances create an adversarial relationship between front-line providers and CCAC supervisors, and forces front-line providers to worry about managing gate-keepers instead of focusing on patient care.
Caretakers Squeezed for Every Penny
An unseemly consequence of the private sector delivery model is to offload costs onto caregivers. Front-line therapists are often required to pay the costs associated with transportation, office equipment and expenses, and insurance. Meanwhile, private agencies absorb a share of home care funding for their salaried bureaucracies.
Front-line workers also bear other longer-term costs associated with contracting — they don’t receive paid vacation time, and must purchase pensions or health benefits separately. Combined with rationing of care and wage stagnation, many professional therapists make far less than they made before privatization, and many personal support workers make significantly below a living wage.
Jones tells us that her husband made under $12,000 last year, and suffered a net loss of almost $500 after taking into account his business costs. Personal service workers, who make up most of the front-line workforce, are also exploited. They aren’t compensated for transportation, travel time, or for on-call time between clients, and their hourly compensation provides considerably less than a living wage.
A Lack of Oversight
Ultimately, these problems continue because of a lack of oversight and transparency. Contracts with therapists can impose gag orders that prevent them from discussing their working conditions or compensation. When challenged, CCACs have publicly discredited whistleblowers.
The Ministry of Health and CCACs may not accurately report patient need — Jones shared with us a mail exchange with a Ministry of Health and Long-Term Care employee indicating that the Ministry may underestimate the need for service by as much as 50 percent. “I wish that I could tell you truly how many are waiting,” she writes. “We don’t have transparency here, that is a real problem”
The Green Party of Ontario Will Help
At a time when Ontario has a big budget deficit and some parties are pushing an austerity agenda, it’s disappointing that the status quo parties ignore gross inefficiencies and misspending on home care.
The Green Party of Ontario will fight to make home care more efficient for the good of service recipients and their caregivers. Green MPPs will fight to:

  • Transfer the delivery of home care therapy services to primary care providers — Family Health Teams and Community Health Centres
  • Expand funding to FHTs and CHCs to provide a full range of embedded therapists in each
  • Aggressively expand the number of Ontario residents enrolled in FHTs and CHCs
  • Phase private service agencies out of the delivery of home care services
  • Have CCACs deliver service directly to those not enrolled in FHTs and CHCs
  • Relocate personal service workers to non-profit agencies as employees