Better at Home 3 Ways to Improve Home and Community Care in Ontario Recommendations to meet the changing needs of clients Ontario Community Support Association 2018
Contents Introduction 01 Impacting clients, communities and the health system 02 Priority 1: Increase and improve services to meet growing client need 04 Priority 2: Stabilize and strengthen the home and community care workforce 05 Priority 3: Strengthen not-for-profit community agencies 06 Conclusion 07 About Home and Community Care and OCSA 08 00
Introduction Angela's Story Angela, a senior living in her Northern Ontario community, had been devoting all her time managing major health issues that left her weak, tired and worn out. She decided to try the one hour seniors exercise classes on Mondays and Thursdays she had read about in the local newspaper being offered by her local community support agency. Angela was surprised at the ability 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 as her overall happiness improved over the summer months. The improvement in Angela's health condition not only improved her quality of life but it delayed the need for more expensive and intensive health services. Photo provided by West Neighborhood House Everyone deserves the chance to live independently in their own home or community for as long as possible. For decades, Ontario s not-for-profit home care and community support service providers have been helping a full range of clients including seniors and people with disabilities do just that. Services such as nursing, personal support services, Meals on Wheels, Alzheimer/adult day programs, transportation to medical appointments, caregiver support, and palliative care are an essential part of Ontario s health system, serving over a million Ontarians per year. Providers in the home and community care sector, with the majority of them being not-forprofit organizations, have been asked to do much more with less for many years. These organizations have successfully achieved improved efficiencies, but are now at the tipping point. Without sufficient and strategic investments, the care that Ontarians prefer and rely on, and the overall sustainability of the health system, will be in jeopardy. Home and community care plays an important role in the sustainability of other health services that Ontarians rely on. A robust home and community care sector enables more efficient hospitals, shorter wait lists for long-term care homes and a healthier population overall. 0
Impacting clients, communities and the health system The services offered by home and community care organizations are as varied as the needs of the people they serve. Our members provide services to a wide range of people with growing, complex needs. Seniors, who in the past, would have been moved into long-term care facilities, are now living at home longer. People with physical disabilities are now actively living in, and contributing to their communities, as opposed to institutional settings. These services leverage volunteers, build partnerships and prevent or delay the need for more intensive care. By embracing a philosophy of independent living, programs such as attendant care services and outreach services offer people with physical disabilities the opportunity to live with dignity in their chosen community, and to participate in every aspect of their life. Fewer appointments are missed, and closer connections with primary care are built thanks to accompaniment, coordination and navigation services. Mobility impairments, cognitive deficits or unavailable caregiver support are no longer barriers for seniors to access primary care in the community. This enables people to stay on top of their health and prevent or delay further decline. Greg's Story Greg is a vibrant, active and giving individual. He is also a person with disabilities who, for the last 18 years has lived independently in Toronto with attendant services provided by a local community support agency in a supportive housing setting. The organization also provides Greg with attendant outreach services, which enable him to volunteer four days a week at Holland Bloorview Kids Rehabilitation Hospital. Volunteering is very important to Greg and he is very proud to be able to give back to the hospital, which is where he previously lived from age 9-18 before moving into his own apartment in the community. Greg has also received support from a specialized rehabilitation centre which helped set up his computer and voiceactivated software as well as assistance with his wheelchair, bed, lift and phone from an occupational therapist with the home care program. Greg has a very positive outlook as he is genuinely appreciative of his ability to live his life as he chooses. The support services that he receives enable him to live his life independently including actively volunteering in the community. Photo provided by Pace Independent Living 02
Arun's Story Arun has been admitted and discharged from hospital more times than he can remember. He has renal system complications which have contributed to various major health concerns. During one of his hospital visits, the staff referred him to a Transitional Care program within his community. Arun and his primary caregiver were reluctant at first to utilize this resource as they were unsure if it would meet all of Arun s needs once he was out of the hospital. However, this all changed when Arun and his family finally agreed to meet with one of the RPN case managers from the Transitional Care program. He would receive dialysis transportation rides three times a week as recommended by the medical staff (pick up and drop off). The program would also offer Personal Support Worker Support Services i.e. Personal Care, assistance with meal preparation, medication reminders, etc. Arun s spouse stated that the PSW assistance he has been receiving three times a day has reduced the pressure and stress of being his only caregiver. She does not feel alone anymore and is very relieved that she and her husband do not have to rely on the hospital system as much as they did in the past. Arun s health has improved significantly since his referral to the Transitional Care program. Photo provided by TransCare Seniors are now able to take charge of their health by defining and working toward their personal health goals. Through home visits, volunteers enable seniors to better define their health goals. With the use of tablet technology, this health care information can be quickly shared with a team of physicians and other health professionals working collaboratively to meet these goals. Thanks to the number of growing transitional care spaces across the province, patients who no longer require hospitalization, now have an opportunity to receive care in their communities. These spaces ensure that people can return home quickly following acute episodic care and receive care in the most appropriate setting. Furthermore, this has the system wide benefit of freeing up scarce hospital capacity to ensure that other patients can access the more urgent care they need. Assisted living providers are delaying admissions to long-term care homes because of their services being provided to seniors. This program allows seniors to access regular visits and 24/7 supports from personal support workers. These examples represent only a small proportion of the multitude of innovative home care and community support services in Ontario that have positive impacts on both individual health, and the broader health care system. 03
Priority 1: Increase and improve services to meet growing client need Ontario s clients and caregivers deserve to receive the right amount of care to meet their needs, regardless of their postal code or care setting. With the aging population, some Local Health Integration Networks (LHINs) have estimated the demand for home and community care services will rise between 3.3% and 7.2% over the next five years, even with a 50% expansion in long-term care capacity. In recent years, the bulk of investment in home and community care has gone into service volume expansion though it still hasn't been enough to keep up with demand across the province. However, these investments channeled directly into new service hours were not accompanied by an increase in base operational funding to service providers. Due to increases in operating costs, this base budget freeze has forced agencies to make difficult decisions, and many have had no choice but to reduce services, create wait lists, or increase client fees to compensate for insufficient government funding. It is time to shift our approach to funding, with an eye towards both expanding services, and building the capacity of organizations to meet ever-growing needs. We need to expand innovative programs that will have impacts across the health system and will lead to a healthier population. Jane's Story Jane is 86 years old and lives comfortably and with a good degree of independence at home following a stroke. She is able to live well on his own with the help of two PSW visits a week from the local CSS agency. In addition, she receives meals on wheels support and she also gets help with medication management to manage her three chronic conditions. These services have kept her from visiting the emergency room. Photo provided by TransCare Transitional care spaces allow people, who may no longer need to be in the hospital but aren t quite ready to go home, to access a higher level of support. They ensure people receive appropriate care in the most appropriate setting. It also has great impact across the entire health system as it frees up hospital and longterm care capacity to better serve patients. All home care and community support services encompass health promotion, preventative services and re-enablement services. They don t stop at meeting a client s current needs; they defend against decline and more serious needs in the future. 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. 04
Priority 2: Stabilize and strengthen the home and community care workforce We believe that improved employee health, security, and satisfaction leads to a higher quality of care for clients. The present fee-forservice funding model in home care discourages full-time and encourages precarious work. We need to find different funding models that encourage full-time work, such as shift-based or clustered care. We also need to ensure we support front-line workers with education and training, good pensions and full benefits. Organizations find themselves at a significant compensation disadvantage when compared to the acute and long-term care sectors due to historical funding challenges. This results in front-line workers having lower salaries and inferior benefits and pensions. While a vast majority of workers in the sector receive some form of retirement benefit (89%) only a small proportion (11%) receive a defined benefit plan such as HOOPP, the standard across much of the health system. The current shortage of personal support workers (PSW) is having ripple effects across the entire health system. There are numerous reports that indicate people are staying in hospitals longer or delaying the start of home care services due to the lack of qualified human resources. The North Simcoe Muskoka LHIN estimates home care demand growth rate is projected to be over 8 times the workforce growth rate over the next 5 years. PSW home care demand growth is projected to be 9 times the workforce growth rate. A Profile of PSWs Working in Home and Community: 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 Photo provided by Wesway A long-term health human resource strategy is needed in order to increase decent work and reduce precarious employment. This strategy has to focus on recruitment, training and compensation, the impact funding models have on front-line workers, and ensuring there is sufficient health human resources capacity to meet growing demand. Source: Sources: Ontario North Simcoe Increasing Muskoka Wages LHIN. for Personal Personal Support Services Examining the Factors Affecting the Gap between Supply and Demand in North Simcoe Support Muskoka. Workers, October Province 2017. of Ontario ad OCSA Wage and OCSA, Benefit Wage Survey and Benefits 2017 Report Survey Results, Final Report, October 2017 05
Priority 3: Strengthen not-for-profit community agencies The delivery of these valuable services by notfor-profit organizations is the key to the sustainability of the health system. It is well understood that synergies between different parts of the health system are vital to build a sustainable health system that delivers positive outcomes and experiences to patients and clients. By combining knowledge and experience, health system experts can collaborate to solve problems which create pressure points in the system. A robust home and community care sector enables more efficient hospitals, shorter wait lists for long-term care homes and a healthier population. The delivery of these valuable services by not-for-profit organizations is the key to the sustainability of the health system. Volunteers in the home and community sector donate over 3.5 million hours of service per year an estimated value of $85 million which would be lost in a for-profit model. This value would be significantly eroded if more for-profit service delivery replaced existing organizations. Additionally, any surplus funds are currently reinvested in improving or expanding service delivery, rather than being directed to owner or shareholder profits. In October of 2017, the province announced the creation of a new provincial organization to deliver personal support services to a subset of home care clients. The goal of this new organization is to provide clients with better choice in regards to selecting their PSW and scheduling their care. There are two major factors which limit the current system s ability to provide this kind of flexibility: a growing shortage of qualified PSWs in some parts of the province, and scheduling constraints arising from client s needs. We believe that the new provincial organization will not be immune to these factors. Therefore, collective efforts with service partners are needed if we are going to meet the growing needs of Ontarians seeking to remain at home and in their communities with the help of high quality health and social services. The government needs to support and not compete with the current home and community care providers to strengthen services for all clients. It is essential that the not-for-profit model be protected. Photo provided by West Neighborhood House 06
Conclusion Whether we re speaking to Ontario s patients, caregivers or care providers, it is clear that the status quo is not going to be enough to meet the growing demand for health services. Though our health care system has made massive strides in recent years, and individual providers and health care workers are doing amazing and innovative work, we hear too many stories of vulnerable Ontarians unable to access sufficient 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 long as possible. We believe that the province can ensure this happens by focusing on leveraging the tremendous value not-for-profit agencies bring to the health care system, and by investing in the frontline workers who are the backbone of home and community care. Home care and community support services makes up about 5% and 2% respectively of the total health care investment, but we re able to punch above our weight because our services go beyond meeting a client s current needs they also protect against decline and the need for more expensive care in the future. The recommendations above are strategic and cost-effective investments with impacts that extend beyond each individual client, and will benefit the health system as a whole. Photo provided by CSC of Essex County 07
About OCSA The Ontario Community Support Association (OCSA) represents nearly 250 not-for-profit organizations that provide home care and community support services that help seniors and people with disabilities live independently in their own homes and communities for as long as possible. These compassionate and cost-effective services improve quality of life and prevent unnecessary hospitalizations, emergency room visits 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 West Toronto, ON M6A 3B6 T: 416-256-3010 / 1-800-267-6272 F: 416-256-3021 2018 OCSA