Report highlights disparity in Ontario’s home and community care sector

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Ontario's disjointed home and community care sector is failing to meet the needs of patients and the exhausted family members who care for them, according to a new report that calls on the provincial government to make the system more transparent, accountable and easier to navigate.

The expert panel, set up by the government and chaired by Gail Donner, a former dean of the faculty of nursing at the University of Toronto, made 16 recommendations on how to fix a home-care system that is working well in some pockets of the province and failing miserably in others.

"Right now, where it's good it's very good," Dr. Donner said. "Where it's not good, it's awful."

The report's recommendations include: Putting in place a charter that would clearly spell out what patients and their caregivers can expect from publicly funded home care; pouring more resources into respite services for overwhelmed caregivers; and making public a "basket of services" so patients understand what is available to them in their homes.

"Many clients told us, 'I don't even know what's available,'" Dr. Donner said. "The ministry could do a lot if it would just tell everybody what the basket of services [is]. We don't have that."

Health Minister Eric Hoskins said in a statement that he endorsed the report and intended to follow its advice. He was not available for an interview Thursday.

The Donner report comes after years of public complaints about how home and community care is delivered in Ontario, a province that is moving aggressively to keep patients out of expensive hospital and nursing home beds.

To facilitate that, the Liberal government has, since taking office in 2003, doubled funding for the local Community Care Access Centres (CCACs) that co-ordinate and deliver care in the home. Total spending on home and community care reached $3.2-billion in 2013-2014, or about 6 per cent of the province's health budget.

But in that same decade, the number of patients receiving services through CCACs has doubled, with a significant spike in the number of high-needs, longer-term patients seeking care, the report says.

Dr. Donner and her colleagues point out in their report that Ontario's 14 CCACs "often have difficulty managing within their budgets due to the combined effect of higher volumes, higher needs and longer times on service than anticipated."

Catherine Brown, the chief executive of the Ontario Association of CCACs, called that "absolutely accurate," and said local funding challenges are something the province must consider as it prepares to modernize the home-care system.

The CCACs themselves have come under fire for steep increases to executive salaries and for the amount of resources they dedicate to administration, rather than front-line care.

The Auditor-General is scheduled to release an audit of the CCACs this spring.

Dr. Donner said it was not within her mandate to say whether the CCACs should be salvaged or scrapped.

France Gélinas, the NDP's health critic, called the report a vindication for the patients and caregivers who have called or visited her office to "just cry and cry and cry" about their struggles with the system.