Private home care would give seniors poorer, inefficient aid

Originally published in the Chronicle Herald by James Hutt, on behalf of signatories listed below this article. James is coordinator for the Nova Scotia Citizens’ Healthcare Network and a member of Solidarity Halifax.

Health and Wellness Minister Leo Glavine recently announced plans to seriously consider opening home care and support services to competitive bidding.

This would allow private, for-profit corporations to bid on contracts currently provided by government and not-for-profit agencies. This competitive bidding process will award home-care contracts based on the lowest bid, not on who will provide the best quality of care.

To date, Mr. Glavine has refused to hold consultations or allow for public input. Seniors’ care is too important to leave to partisan political interest.

In response, the Nova Scotia Citizens’ Health Care Network is hosting a series of town hall meetings across the province. The next three will be in Sydney on April 21, in Amherst on April 30, and in Halifax on May 4. Details can be found online at www.nshealthcoalition.ca.

We are deeply concerned by this move. The wait list for home care in Nova Scotia has been rapidly expanding. Over a six-month period in 2014, the wait list increased by 80 per cent, from 422 to 760 patients needing care. With the oldest population in the country, and some of the highest rates of chronic illness, this trend is sure to continue.

Ontario provides a warning for competitive bidding. Ontario opened its home-care system to private bidders in the mid-1990s. Private transnational corporations came in and underbid charities and non-profit providers with deep roots in communities. After winning contracts, they reduced home visits to 30- or 60-minute “products,” and added to the number of clients whom workers see. The amount of time allotted for travel between patients decreased, too, often forcing health workers to choose between leaving early and working without pay.

The drive for profit does not end with limiting services and care. Private companies in Ontario are known to “upsell” care to patients, pushing them to buy unnecessary features and services with extra out-of-pocket payments. This has become such a problem that Ontario’s auditor general has stressed the need for consumer protection to prevent companies from taking advantage of patients.

Contracting out of home care is proven to increase worker turnover, meaning patients will have little continuity of caregivers entering their home. After winning contracts, corporations made jobs more casual and precarious while reducing wages and benefits. Predictably, this created high rates of turnover and severe shortages in health workers.

Patients need to feel familiar with the nurses and care workers entering their homes, confident that they know their individual needs, medications and routines.

Yet the opposite has happened. Ontario has a turnover rate of home-care workers of 57 per cent per year. Across Canada, not-for-profit agencies with unionized staff offer the most consistency for patients. Turnover for unionized home-care workers is 15 per cent, compared to 25 per cent for non-unionized, and 50 per cent with non-unionized, for-profit firms.

The combination of short supplies of health workers and limited competition of providers, especially in rural areas, resulted in higher bids for home-care contracts and increased inefficiency. The system is riddled with such redundancy that administration costs are estimated at 30 per cent.

It is not surprising, then, that in 2010 Ontario’s auditor general rebuked that province’s home-care system for being “inequitable, insufficient, and ineffectively measured and managed.” Since then, there have been two moratoriums on competitive bidding.

Nova Scotia already has a shortage of health-care providers. Nurses and home support workers will not remain in an industry where their wages are threatened and their employment is precarious, particularly when they can readily find employment in the acute and long-term care sectors, as well as out of province.

Our seniors and chronically ill deserve better. They are now receiving care at home that at one time could only be delivered in a hospital setting. They deserve the same guarantees as hospital patients — high quality care, accessible to all.

We’re calling for the government to reverse moves to privatize home care, and to instead maintain a publicly funded, not-for profit system, which should provide home-care services at little or no cost to patients and their families.

Add your voice and support our seniors and chronically ill. Sign the petition online: votepublichealthcare.ca/take-action/keep-home-care-public and join us May 6 in a provincewide day of action.

Submitted by James Hutt, Nova Scotia Citizens’ Health Care Network on behalf of fellow signatories:
Adrienne Silnicki, Canadian Health Coalition
Christine Saulnier, Canadian Centre for Policy Alternatives;
Pamela Harrison, Transition House Association of Nova Scotia
Charity Fraser and Jeanne Fay, Second Story Women’s Centre, Bridgewater
Louise Smith MacDonald, Every Woman’s Centre, Sydney
Bernadette MacDonald, Tri-County Women’s Centre, Yarmouth
Stella Lord, Community Society to End Poverty
Angela Giles, Council of Canadians
Rick Clarke, Nova Scotia Federation of Labour
Janet Hazelton, Nova Scotia Nurses’ Union
Joan Jessome, NSGEU
Danny Cavanagh, CUPE Nova Scotia
Jeannie Baldwin, PSAC
Loretta Melanson, Services Employees International Union – Local 2, Branch N.S.
Kyle Buott, Halifax Dartmouth District Labour Council.