Better at Home

Ontario Community Support Association2018

3 Ways to Improve Home and Community Care in Ontario

Recommendations to meet the changing needs of clients

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Contents

Introduction

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Priority 1: Increase and improve services to meet growing client need

Priority 2: Stabilize and strengthen the home and community care workforce

Priority 3: Strengthen not-for-profit community agencies

Conclusion

08About Home and Community Care and OCSA

Impacting clients, communities and the health system

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Everyone deserves the chance to liveindependently in their own home or communityfor as long as possible. For decades, Ontario’snot-for-profit home care and communitysupport service providers have been helping afull range of clients – including seniors andpeople with disabilities – do just that. Servicessuch as nursing, personal support services,Meals on Wheels, Alzheimer/adult dayprograms, transportation to medicalappointments, caregiver support, and palliativecare are an essential part of Ontario’s healthsystem, serving over a million Ontarians peryear. Providers in the home and community caresector, with the majority of them being not-for-profit organizations, have been asked to domuch more with less for many years. Theseorganizations have successfully achievedimproved efficiencies, but are now at thetipping point. Without sufficient and strategicinvestments, the care that Ontarians prefer andrely on, and the overall sustainability of thehealth system, will be in jeopardy. Home and community care plays an importantrole in the sustainability of other health servicesthat Ontarians rely on. A robust home andcommunity care sector enables more efficienthospitals, shorter wait lists for long-term carehomes and a healthier population overall.

Introduction

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Angela, a senior living in her NorthernOntario community, had been devoting allher time managing major health issues thatleft her weak, tired and worn out. She decided to try the one hour seniorsexercise classes on Mondays and Thursdaysshe had read about in the local newspaperbeing offered by her local communitysupport agency. Angela was surprised at theability and agility of seniors older than her,and was motivated to give it a try. The exercises were just what she needed -gentle but strengthening. Her muscle strength and balance improved,and gradually, her general agility, as well asher overall happiness improved over thesummer months. The improvement in Angela's healthcondition not only improved her quality oflife but it delayed the need for moreexpensive and intensive health services. 

Angela's Story

Photo provided by West Neighborhood House

Impacting clients, communities and the health system

The services offered by home and communitycare organizations are as varied as the needs ofthe people they serve. Our members provideservices to a wide range of people with growing,complex needs. Seniors, who in the past, would have beenmoved into long-term care facilities, are nowliving at home longer. People with physicaldisabilities are now actively living in, andcontributing to their communities, as opposedto institutional settings. These services leveragevolunteers, build partnerships and prevent ordelay the need for more intensive care. By embracing a philosophy of independentliving, programs such as attendant care servicesand outreach services offer people withphysical disabilities the opportunity to live withdignity in their chosen community, and toparticipate in every aspect of their life. Fewer appointments are missed, and closerconnections with primary care are built thanksto accompaniment, coordination andnavigation services.  Mobility impairments,cognitive deficits or unavailable caregiversupport are no longer barriers for seniors toaccess primary care in the community. Thisenables people to stay on top of their healthand prevent or delay further decline.  

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Greg's StoryGreg is a vibrant, active and givingindividual.   He is also a person withdisabilities who, for the last 18 years haslived independently in Toronto withattendant services provided by a localcommunity support agency in a supportivehousing setting.   The organization also provides Greg withattendant outreach services, which enablehim to volunteer four days a week atHolland Bloorview Kids RehabilitationHospital.  Volunteering is very important toGreg and he is very proud to be able togive back to the hospital, which is wherehe previously lived from age 9 - 18 beforemoving into his own apartment in thecommunity. Greg has also received support from aspecialized rehabilitation centre whichhelped set up his computer and voice-activated software as well as assistancewith his wheelchair, bed, lift and phonefrom an occupational therapist with thehome care program. Greg has a very positive outlook as he isgenuinely appreciative of his ability to livehis life as he chooses.   The supportservices that he receives enable him to livehis life independently including activelyvolunteering in the community.  Photo provided by Pace Independent Living

Seniors are now able to take charge of theirhealth by defining and working toward theirpersonal health goals. Through home visits,volunteers enable seniors to better define theirhealth goals. With the use of tablet technology,this health care information can be quicklyshared with a team of physicians and otherhealth professionals working collaboratively tomeet these goals. Thanks to the number of growing transitionalcare spaces across the province, patients whono longer require hospitalization, now have anopportunity to receive care in theircommunities. These spaces ensure that peoplecan return home quickly following acuteepisodic care and receive care in the mostappropriate setting. Furthermore, this has thesystem wide benefit of freeing up scarcehospital capacity to ensure that other patientscan access the more urgent care they need. Assisted living providers are delayingadmissions to long-term care homes because oftheir services being provided to seniors. Thisprogram allows seniors to access regular visitsand 24/7 supports from personal supportworkers. These examples represent only a smallproportion of the multitude of innovative homecare and community support services in Ontariothat have positive impacts on both individualhealth, and the broader health care system.

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Arun's StoryArun has been admitted and dischargedfrom hospital more times than he canremember. He has renal systemcomplications which have contributed tovarious major health concerns. During oneof his hospital visits, the staff referred himto a Transitional Care program within hiscommunity. Arun and his primarycaregiver were reluctant at first to utilizethis resource as they were unsure if itwould meet all of Arun’s needs once hewas out of the hospital. However, this all changed when Arun andhis family finally agreed to meet with oneof the RPN case managers from theTransitional Care program. He wouldreceive dialysis transportation rides threetimes a week as recommended by themedical staff (pick up and drop off). Theprogram would also offer PersonalSupport Worker Support Services i.e.Personal Care, assistance with mealpreparation, medication reminders, etc. Arun’s spouse stated that the PSWassistance he has been receiving threetimes a day has reduced the pressure andstress of being his only caregiver. She doesnot feel alone anymore and is very relievedthat she and her husband do not have torely on the hospital system as much asthey did in the past. Arun’s health hasimproved significantly since his referral tothe Transitional Care program.Photo provided by TransCare

Priority 1: Increase and improve services to meet growing client need

Ontario’s clients and caregivers deserve toreceive the right amount of care to meet theirneeds, regardless of their postal code or caresetting. With the aging population, some Local HealthIntegration Networks (LHINs) have estimatedthe demand for home and community careservices will rise between 3.3% and 7.2% overthe next five years, even with a 50% expansionin long-term care capacity.  In recent years, the bulk of investment in homeand community care has gone into servicevolume expansion – though it still hasn't beenenough to keep up with demand across theprovince. However, these investmentschanneled directly into new service hours werenot accompanied by an increase in baseoperational funding to service providers. Due to increases in operating costs, this basebudget freeze has forced agencies to makedifficult decisions, and many have had nochoice but to reduce services, create wait lists,or increase client fees to compensate forinsufficient government funding. It is time to shift our approach to funding, withan eye towards both expanding services, andbuilding the capacity of organizations to meetever-growing needs. We need to expand innovative programs thatwill have impacts across the health system andwill lead to a healthier population.

Transitional care spaces allow people, who mayno longer need to be in the hospital but aren’tquite ready to go home, to access a higher levelof support. They ensure people receiveappropriate care in the most appropriatesetting. It also has great impact across the entirehealth system as it frees up hospital and long-term care capacity to better serve patients. All home care and community support servicesencompass health promotion, preventativeservices and re-enablement services. They don’tstop at meeting a client’s current needs; theydefend against decline and more serious needsin the future.

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Jane's StoryJane is 86 years old and lives comfortablyand with a good degree of independenceat home following a stroke. She is able to live well on his own with thehelp of two PSW visits a week from thelocal CSS agency.  In addition, she receives meals on wheelssupport and she also gets help withmedication management to manage herthree chronic conditions. These services have kept her from visitingthe emergency room.

Photo provided by TransCare

Sources: North Simcoe Muskoka LHIN. Personal Support Services Examining the Factors Affecting the Gap between Supply and Demand in North Simcoe Muskoka. October 2017.Mississauga Halton LHIN. Meeting Senior Care Needs Now and in the Future – Highlights and Key Findings. May 2015.Central West LHIN Meeting Senior Care Needs Now and in the Future – Highlights and Key Findings. May 2015.

Priority 2: Stabilize and strengthen the home and community care workforce

We believe that improved employee health,security, and satisfaction leads to a higherquality of care for clients. The present fee-for-service funding model in home carediscourages full-time and encouragesprecarious work. We need to find differentfunding models that encourage full-time work,such as shift-based or clustered care. We alsoneed to ensure we support front-line workerswith education and training, good pensions andfull benefits. Organizations find themselves at a significantcompensation disadvantage when compared tothe acute and long-term care sectors due tohistorical funding challenges. This results infront-line workers having lower salaries andinferior benefits and pensions. While a vastmajority of workers in the sector receive someform of retirement benefit (89%) only a smallproportion (11%) receive a defined benefit plansuch as HOOPP, the standard across much ofthe health system. The current shortage of personal supportworkers (PSW) is having ripple effects acrossthe entire health system. There are numerousreports that indicate people are staying inhospitals longer or delaying the start of homecare services due to the lack of qualified humanresources. The North Simcoe Muskoka LHIN estimateshome care demand growth rate is projected to

be over 8 times the workforce growth rate overthe next 5 years. PSW home care demandgrowth is projected to be 9 times the workforcegrowth rate.

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A long-term health human resource strategy isneeded in order to increase decent work andreduce precarious employment. This strategyhas to focus on recruitment, training andcompensation, the impact funding models haveon front-line workers, and ensuring there issufficient health human resources capacity tomeet growing demand.

There are over 34,000 PSWs working in the home and community sector.

The median annual salary is $35,802. 

The average length of employment with

same employer is 5.5 years.

33% reported having a tenure of more than 10+ years with the same employer

Only 38% of PSW positions were reported as

full-time equivalents (FTE)

In contrast, it was 65% for registered practical nurses.

Source: Ontario Increasing Wages for Personal Support Workers, Province of Ontario ad OCSA Wage and Benefit Survey 2017

A Profile of PSWs Working in Home and Community:

Photo provided by Wesway

Source: Ontario Increasing Wages for Personal Support Workers, Province of Ontario ad OCSA Wage and Benefit Survey 2017

Sources: North Simcoe Muskoka LHIN. Personal Support Services Examining the Factors Affecting the Gap between Supply and Demand in North Simcoe Muskoka. October 2017.OCSA, Wage and Benefits Report – Survey Results, Final Report, October 2017

Priority 3: Strengthen not-for-profit community agencies

The delivery of these valuable services by not-for-profit organizations is the key to thesustainability of the health system. It is wellunderstood that synergies between differentparts of the health system are vital to build asustainable health system that delivers positiveoutcomes and experiences to patients andclients. By combining knowledge andexperience, health system experts cancollaborate to solve problems which createpressure points in the system. A robust home and community care sectorenables more efficient hospitals, shorter waitlists for long-term care homes and a healthierpopulation. The delivery of these valuableservices by not-for-profit organizations is thekey to the sustainability of the health system. Volunteers in the home and community sectordonate over 3.5 million hours of service peryear– an estimated value of $85 million whichwould be lost in a for-profit model. This valuewould be significantly eroded if more for-profitservice delivery replaced existing organizations.Additionally, any surplus funds are currentlyreinvested in improving or expanding servicedelivery, rather than being directed to owner orshareholder profits. It is essential that the not-for-profit model beprotected.

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In October of 2017, the province announced thecreation of a new provincial organization todeliver personal support services to a subset ofhome care clients. The goal of this neworganization is to provide clients with betterchoice in regards to selecting their PSW andscheduling their care.  There are two major factors which limit thecurrent system’s ability to provide this kind offlexibility: a growing shortage of qualified PSWsin some parts of the province, and schedulingconstraints arising from client’s needs. Webelieve that the new provincial organization willnot be immune to these factors. Therefore, collective efforts with servicepartners are needed if we are going to meet thegrowing needs of Ontarians seeking to remainat home and in their communities with the helpof high quality health and social services. The government needs to support and notcompete with the current home andcommunity care providers to strengthenservices for all clients.

Photo provided by West Neighborhood House

Whether we’re speaking to Ontario’s patients, caregivers or care providers, it is clear that the status quo isnot going to be enough to meet the growing demand for health services. Though our health care systemhas made massive strides in recent years, and individual providers and health care workers are doingamazing and innovative work, we hear too many stories of vulnerable Ontarians unable to accesssufficient care when and where they need it. OCSA knows that the home and community care sector can,and must do more to ensure Ontarians are able to live independently in health and happiness for as longas possible. We believe that the province can ensure this happens by focusing on leveraging the tremendous valuenot-for-profit agencies bring to the health care system, and by investing in the frontline workers who arethe backbone of home and community care. Home care and community support services makes up about5% and 2% respectively of the total health care investment, but we’re able to punch above our weightbecause our services go beyond meeting a client’s current needs – they also protect against decline andthe need for more expensive care in the future. The recommendations above are strategic and cost-effective investments with impacts that extendbeyond each individual client, and will benefit the health system as a whole.

Conclusion

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The Ontario Community Support Association (OCSA) represents nearly 250 not-for-profit organizationsthat provide home care and community support services that help seniors and people with disabilities liveindependently in their own homes and communities for as long as possible. These compassionate andcost-effective services improve quality of life and prevent unnecessary hospitalizations, emergency roomvisits and premature institutionalization. They are the key to a sustainable health care system for Ontario.For more information, visit www.ocsa.on.ca. 104-970 Lawrence Avenue WestToronto, ON  M6A 3B6T: 416-256-3010 / 1-800-267-6272  F: 416-256-3021© 2018 OCSA

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