The Decline of Community-Based Healthcare in Ontario

Posted by Steve Jones

Sun, Oct 12, 2014

For nearly 20 years, Ontarios provincial government has been shifting care from hospitals to outpatient services in the community, the so-called community-based care model. While it sounds good on paper ” the right care, in the right place, at the right time ” the reality is that the push to community-based healthcare has been failing Ontario citizens. The reduction in funding for hospitals has not been transferred to home care and other community-based services. In fact, per capita funding for home care declined 14% between 2004 and 2009. (2010 Annual Report of the Office of the Auditor General of Ontario). How much more has it declined in the last 5 years?

Ontario hospitals have had to cut beds and reduce access to in-hospital restorative care and rehabilitation therapies to the point that there is often a wait of 2 to 10 months for certain in-hospital services that are not available in the community. This might be OK for a young patient in overall good health, but for the frail and elderly, its a disaster.

Today Ontario has not only fewer beds, but also fewer staff than in the 1990s, when the community-based care model was first implemented, yet our population has increased and is older, needing more care both in and out of the hospital. Lack of funding for home health care means that those who have to leave the hospital early cant get the care they need at home, either. The government increased funding for community care about 5% per year between 2004 and 2009, but the number of clients served increased more than 11% per year. (2010 Annual Report of the Office of the Auditor General of Ontario) That adds up (or subtracts) to a 14% reduction in community care services delivered.

Home care is coordinated by CCACs, who determine eligibility based on a number of criteria, including whether family, friends, volunteers, and paid services, such as cleaning services and grocery delivery are able to provide care. Family members, mostly women, are the ones who end up shouldering the lions share of that burden. Family members often lack the knowledge and experience needed for specialized care; and taking care of a loved one is often a full-time job, adding a financial hardship to the emotional and physical ones.

Wed like to see these improvements (as well as a host of others):

• Give everyone the in-hospital care and therapies they need.
• Increase funding for community care based on actual usage, not just a number on paper.
• Raise staffing levels for restorative, rehabilitative and nursing care to Canada-wide standards.
• Restore beds in hospitals so that there is a bed for everyone who needs one.
• Improve the quality of home care support, based on need, not how little you can get away with.

Of course, we could wish upon a star, too, and that would likely produce results as quickly as waiting for the government to fix the problem. In the meantime, you can get help and advocacy from Qualicares nurse-managed private home and hospital care, working to maximize your CCAC and Ontario health care benefits.