Ontario's Health Minister is promising a new model for home care that directs more money to front-line services after the release of another damning report on the province's troubled system.
The latest findings are in the annual report of Ontario Auditor-General Bonnie Lysyk, and describe a system in which the care available varies depending on where a person lives and the time of year, performance targets are often missed and not enough is done to ensure agencies contracted to deliver care are doing their jobs.
The new report is the second instalment of an 18-month investigation into the workings of the home-care system. In a report issued in September, the Auditor-General advised the province to take a "hard look" at the way home care is delivered after finding that as little as 61 cents of every dollar spent goes to face-to-face client services. The earlier report also found gaps in the levels of care offered across the province.
A report to the government from a blue-ribbon panel in the spring called on the province to make home-care services easier to navigate and more accountable. An investigation by The Globe and Mail also found a system plagued by uneven access to care, byzantine processes and a troubling lack of transparency for patients and family caregivers.
The province is expected to release a policy paper as early as this month that will propose scrapping the existing system that delivers care through 14 agencies called Community Care Access Centres, and giving more authority to the province's local health networks.
Health Minister Eric Hoskins said on Wednesday that the discussion paper will address many of the issues raised in this audit and other reports, including the structure of the system and inconsistency in care.
"What I am aiming to do is find the best of what works and bring it together in perhaps a new model and direct more scarce dollars to front-line services," he said.
Ontario has moved more aggressively than other provinces to transfer an increasing amount of care out of expensive hospitals and long-term care and into the home, but the system for delivering that care has been a lightning rod for criticism for several years.
The latest report by the Auditor-General takes an in-depth look at three of the province's 14 access centres – the Central CCAC based in north Toronto, the North East CCAC based in Sudbury and the Champlain CCAC based in Ottawa.
It found inconsistencies in services, in policies on issues such as wait times and standards of care. For example, people assessed with similar needs would receive five hours of weekly personal support to help with activities such as bathing in one region, eight hours in another and 10 in the third. Eligible clients who applied in July would get support at that time, but would be put on a waiting list if they applied in September, when the agencies, which cannot run deficits, were trying to balance their books by year end.
Such delays or lack of personal support for some clients "could aggravate their health condition and cause them to suffer unnecessarily," the report says.
"The basic issues that we started with are still there," Ms. Lysyk said at a news conference to discuss the report.
Most home care in Ontario is delivered under contract by non-profit agencies and for-profit companies, but the audit found CCACs do not consistently visit these providers to ensure they are complying with contract terms or deal with under-performance in a consistent way.
The Auditor-General's annual report also looked at the performance of the province's 14 Local Health Integration Networks – the agencies expected to gain new powers under forthcoming provincial reforms.
In the eight years since the LHINs were created, the audit found the province has failed to define their role clearly or establish measures to judge their performance.
"This makes it difficult to determine whether they are delivering value for money," Ms. Lysyk concluded.
Conservative health critic Jeff Yurek questioned why the province is taking so long to make reforms, and said he will look for targets and goals when the Liberals unveil their plan.
"How can you fix a system when you don't know what you are looking for at the end of the day," he said.