Realizing the Potential of Home Care
Competing for Excellence by Rewarding Results
A Review of the competitive bidding process used by Ontario's Community Care Access Centres (CCACs) to select providers of goods and services.
The Goal : Improve home care - "the next essential service"
"The McGuinty Government is ensuring Ontarians receive the highest quality home care services by appointing the Honourable Elinor Caplan to conduct an independent review of the competitive bidding process used by Community Care Access Centres (CCACs) to select service providers."
- Hon. George Smitherman, Minister of Health and Long-Term Care, October 4, 2004
The Ministry of Health and Long Term Care provides, through its Community Health Division, transfer payments to 42 Community Care Access Centres, (CCACs) and to approximately 800 community support service (CSS) agencies for the delivery of community-based services. The funding is used to provide professional, homemaking and personal support services at home for people who would otherwise need to go to, or stay longer in, hospitals or long-term care homes. Funding is also provided to assist frail elderly people and people with disabilities to live as independent as possible in their own homes.
The Ministry provided approximately $1.6 billion for CCACs and CSS agencies in 2003/2004. In its recent report, the Office of the Provincial Auditor raised a number of concerns with home care in Ontario, including the need for a funding formula that more fully allocates funds based on assessed needs; measures to demonstrate clients are in fact receiving quality care; and an information system to collect client-level service and costing data.
We heard these same concerns from our consultation sessions, and from submissions to this review. In particular the desire for quality care was paramount in most discussions and submissions. This report and its recommendations address these concerns, and, in effect, provide a 'how to' manual that will lead to better quality service for Ontario's home care clients and their families.
The review makes its recommendations in the context of a competitive service delivery model.We assessed a number of procurement models during the course of our review, and have selected the best elements from a variety of these models to design a procurement solution specifically made for Ontario.
The CCAC Procurement Review completed its work on a tight, six-month time line. During that time, the Procurement Review traveled the province, meeting with over 200 groups and organizations. The Review received over 80 submissions and 50 letters. In addition, the Procurement Review commissioned research among home care clients, home care workers and the general public.
Getting to the quality goal
Better quality home care is a shared goal, and developing recommendations that will ensure that we reach this goal, is the primary focus of this Report.
Through better quality care, home care will achieve better client service. Quality will improve continuously as benchmarking and best practices are employed, as changes are implemented that will stabilize the workforce, as more consistency of care is available, and as services are streamlined.
The same initiatives and reforms that will result in better client service will also result, if implemented, in greater value for taxpayer's money. The best quality care and the most effective use of funds are not mutually exclusive concepts. They are complementary and mutually reinforcing.
The biggest challenge facing home care is that there is a clear need for consistent, accessible information that can provide a basis to measure client outcomes, disseminate research and best practices and report on overall home care performance. Stakeholders across Ontario would like to see streamlined processes, increased consistency and greater transparency for all procurement practices.
Ensuring continuity of care, in all its forms, was a challenge identified by providers, workers and clients alike. Many expressed a desire to see more stability in the sector and greater attention to worker and client satisfaction.
A major challenge addressed by the Procurement Review was the misalignment of incentives to foster innovation and encourage cooperation in home care.
The CCAC Procurement Review makes 70 recommendations, which will allow home care to realize its potential in the best interests of clients and their families.
The most important recommendation, from which all else flows, is the need to establish the Centre for Quality and Research in Home Care (CQR). Accurate information is the foundation on which to build a home care sector that is focused on continuous improvement, innovation, and best practices, all of which must be aimed at the ultimate goals : client and family satisfaction. The CQR would collect consistent information and set key performance indicators with a view to providing more effective, higher quality service to home care clients. Other key recommendations would :
- Implement a province-wide, one-stop certification process to replace the current patchwork of prequalification requirements.
- Allow for longer-term contracts for those providers who demonstrate excellence in service to clients.
- Change the way care agencies are paid, from "fee for service" or "per visit" to "fee for client." In other words, establish a client-focused envelope of funding so care is delivered based on real client needs rather than the number of visits made.
- Provide more choice, more flexibility, more and better information for clients and their families about their care options and rights.
- Establish ways to standardize and collect better information for the use of service providers and CCACs to measure progress, improvements and success in the home care sector.
- Obtain better value for money in the procurement of medical equipment and supplies.
- Make home care a priority for the Government's Information Technology and Transformation agenda.
- Protect and enhance workers rights. A satisfied workforce leads to better quality service for clients and part of delivering satisfaction comes from delivering choice. Workers want choice. Part-time casual and full-time work should both be encouraged and seen as valid employment practices, and all employees should benefit from the protections of the Employment Standards Act.
- Clarify the roles and responsibilities of the Ministry of Health and Long-Term Care, CCACs, Case Managers and Boards of Governors.
Cost-effective and health-effectivechoices
It is of concern that home care funding has been declining as a percentage of total health care spending over the past few years. The Procurement Review commends the McGuinty Government's commitment to reverse this trend by allocating new investment in the sector beginning in 2003/2004.
Home care must be viewed in the context of, not in isolation from, the hospital sector. Ontarians deserve a seamless continuum of care, when needed, as close to home as possible. Effective home care is a key element in the ongoing transformation to a more community-based system of care.
It is both more cost-effective, and more health-effective, to provide appropriate care in the home. Studies show that people get better faster at home. People are generally happier, and recover faster both physically and mentally at home.
The CCAC Procurement Review believes that implementing the recommendations in this report will transform home care to enable more people to remain in their homes and communities. The review's recommendations can be implemented at moderate cost over the next three years (see timeline for implementation of recommendations on page 68). Implementing the Review's recommendations can - and should - play a significant role in realizing the potential of home care in Ontario.